Texas Department of Aging and Disability Services 2016 Reference

Transcription

Texas Department of Aging and
Disability Services (DADS)
2016
REFERENCE
GUIDE
Per DADS Budget Strategies
2016 Reference Guide
Per DADS Budget Strategies
Texas Department of Aging and Disability Services
P.O. Box 149030 • Austin, Texas 78714-9030
512-438-3011
www.dads.state.tx.us
Jon Weizenbaum
Commissioner
Table of Contents
Introduction .................................................................................................................................. 3
Section I: Overview
Health and Human Services (HHS) in Texas ................................................................................. 6
Texas Department of Aging and Disability Services (DADS) .............................................................. 8
Strategic Planning and Budgeting Goals ........................................................................................... 8
Guiding Principles ................................................................................................................................ 9
DADS Organizational Structure ....................................................................................................... 10
DADS Organizational Chart ............................................................................................................. 14
Budget Summary ................................................................................................................................ 15
Staffing Summary ................................................................................................................................ 16
Section II: Programs and Services
Intake, Access and Eligibility ................................................................................................................... 18
Community Services and Supports – Medicaid Entitlement .............................................................. 29
Community Services and Supports Waiver Programs ......................................................................... 35
Community Services and Supports – Non-Medicaid .......................................................................... 46
Nursing Facility and Hospice Payments ................................................................................................. 63
Intermediate Care Facilities – Individuals With Intellectual Disability Services .............................. 72
State Supported Living Center Services ................................................................................................. 75
Regulation, Certification and Outreach ................................................................................................. 78
Indirect Administration ........................................................................................................................... 87
Section III: Demographic and Economic Data
Projected Texas Population • Total and Poverty by Region and Age Group .................................... 90
Texas Population Trends by Age Group ................................................................................................ 91
U.S. Population Trends by Age Group ................................................................................................... 91
Texas Population by Race and Region .................................................................................................... 92
Texas Population by Region and Sex ..................................................................................................... 92
Texas Aged and Disabled Population by Region and Poverty Status................................................. 93
Texas Non-Older Disabled Population by Region and Poverty Status............................................... 93
Poverty Income Guidelines for the Continental United States • Actual by Year ............................. 94
Median Income for Texas • Estimated by Federal Fiscal Year ............................................................ 94
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Section III: Demographic and Economic Data (cont.)
Per Capita Personal Income • Estimated/Projected by Year ............................................................... 94
Labor Force Statistics for Texas and the U.S. by Federal Fiscal Year ................................................. 95
Labor Force Statistics for Texas • Calendar Year 2012 by HHS Region ............................................ 95
State Rankings ........................................................................................................................................... 96
Section IV: Appendices
Volunteer and Community Engagement .............................................................................................. 98
Interest List Information ....................................................................................................................... 100
Functional Needs Assessment Process ................................................................................................ 103
Medical Necessity Determination Process............................................................................................ 104
Toll-free Hotline Numbers .................................................................................................................... 105
Headquarters Directory ......................................................................................................................... 106
Contacts ................................................................................................................................................... 107
Area Agencies on Aging ........................................................................................................................ 109
Texas Map with Area Agencies on Aging by County ........................................................................ 109
Aging and Disability Resource Centers ............................................................................................... 115
Texas Map with Aging and Disability Resource Centers by County ............................................... 115
Foster Grandparent Program ................................................................................................................ 120
Texas Map with Foster Grandparent Program Locations by County .............................................. 120
Local Intellectual and Developmental Disability Authorities .......................................................... 122
Texas Map with Local Intellectual and Developmental Disability Authorities
by County ................................................................................................................................................ 122
State Supported Living Centers ............................................................................................................ 131
Texas Map with State Supported Living Centers by County ............................................................ 131
Regional Directors for Community Services ...................................................................................... 134
Regional Directors and Assistant Regional Directors for Regulatory Services .............................. 135
Texas Counties by HHS Region ............................................................................................................ 136
Texas Map with Regional and County Boundaries ............................................................................ 134
STAR+PLUS Program ........................................................................................................................... 139
STAR Program in the Medicaid Rural Service Area .......................................................................... 140
Glossary ................................................................................................................................................... 141
Acronyms ................................................................................................................................................ 157
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Introduction
The DADS Reference Guide provides an overview of the programs
and services administered by DADS. The publication compiles
information from a variety of sources into one comprehensive
reference document.
The level of detail in the DADS Reference Guide is
intended to help DADS employees and Texas residents
become better acquainted with services available through
DADS. The publication is an accurate, comprehensive and
easily accessible reference for frequently asked questions.
However, caution must be exercised in basing significant
decisions on this information before first verifying the
details with the appropriate agency personnel. Although
efforts have been made to ensure the accuracy of the
information, the printed version may not reflect the most
current policies and procedures.
The DADS Reference Guide is organized
into four major sections:
Section I • Agency Overview describes the state’s health and human services system, the background
of DADS and the DADS vision, mission, key responsibilities and guiding principles. The DADS
organizational structure is described and an organizational chart is provided. DADS strategic
planning goals, as well as budget and staffing summaries, are also included.
Section II • Programs and Services provides detailed descriptions for each of the programs and services
administered by DADS, categorized by DADS FY 2014–15 Legislative Appropriations Request
(LAR) strategies. Standard information is presented for each of the programs or services, including
descriptions, eligibility requirements and statewide caseload data.
Section III • Demographic/Economic Data contains data that are crucial to DADS planning functions.
Included are total and poverty population data for Texas by age group and by region; Texas
population that is older and has disabilities, broken down by region and poverty status; Texas total
population by region, race and gender; Texas labor force statistics by region, and per capita personal
income amounts. In some instances, national data are also provided for comparison.
Other data in this section include the poverty income guidelines for the continental United States and
Texas state median income. State ranking information that may be of interest is also included at the
end of this section.
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Section IV • Appendices contains directories for DADS headquarters, area agencies on aging (AAAs),
local intellectual and developmental disability authorities (LIDDAs), state supported living centers,
regional directors for community services and regional directors for regulatory services. There is a
list of contacts for additional information about specific DADS programs or services, and a list of
toll-free hotline phone numbers. Brief descriptions of the functional assessment process, the medical
necessity determination process and interest lists are also provided. In addition, a table showing each
of Texas’ 254 counties by region, a glossary of frequently used terms and a table of commonly used
acronyms are included.
Note: This publication is available online at www.dads.state.tx.us/news_info/budget/
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Section 1:
Overview
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Health and Human Services in Texas
DADS
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Overview
Health and human services in Texas are organized into five state agencies:
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Texas Health and Human Services Commission (HHSC)
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Texas Department of Aging and Disability Services (DADS)
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Texas Department of Assistive and Rehabilitative Services (DARS)
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Texas Department of Family and Protective Services (DFPS)
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Texas Department of State Health Services (DSHS)
Each agency has a nine-member, governor-appointed council that makes recommendations regarding
rules and policies. Final approval rests with the Texas Health and Human Services Commission
(HHSC).
The Texas Health and Human Services Commission oversees the operations of the health and human services
system and provides administrative oversight of Texas health and human services programs. HHSC also
provides direct administration of Medicaid, the Children’s Health Insurance Program, Supplemental
Nutrition Assistance Program (SNAP) benefits (food stamps), Temporary Assistance for Needy Families
and various other assistance programs.
The Texas Department of Aging and Disability Services provides long-term services and supports to a wide
range of people, including:
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People with physical disabilities.
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People with intellectual and developmental disabilities and related conditions.
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People age 60 and older.
DADS also regulates providers of long-term services and supports and administers the state’s
guardianship program.
The Texas Department of Assistive and Rehabilitative Services works with Texans with disabilities and
families with children who have developmental delays to improve the quality of their lives and to enable
their full participation in society. This includes:
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Working with Texans who are blind or visually impaired to help them reach their goals.
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Helping people with disabilities achieve employment goals and independent living.
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ssuring that families with young children with developmental delays have the resources and support
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they need to reach their goals.
orking to improve the quality of life for Texans with disabilities who apply for or receive Social
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Security Administration disability benefits, by making timely and accurate disability determinations.
Section I
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The Texas Department of Family and Protective
Services is charged with protecting children,
adults who are aging or have disabilities living
at home or in state facilities, and licensing
group day care homes, day care centers and
registered family homes. DFPS is also charged
with managing community-based programs
that prevent delinquency, abuse, neglect and
exploitation of Texas children, aging Texans and
adults with disabilities. The agency’s services are
provided through its Adult Protective Services,
Child Protective Services and Child Care
Licensing divisions.
Overview
The Texas Department of State Health Services
promotes optimal health for people and
communities while providing effective health,
mental health and substance abuse services to Texans. DSHS administers programs that:
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ocus on substance abuse prevention and assistance to people with mental health or substance
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abuse problems.
Protect consumer health and safety.
rovide essential public health services focusing on population-based prevention and
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health promotion.
rovide a health care “safety net,” generally for people who do not have health care coverage through
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private insurance, Medicaid or the Children’s Health Insurance Program (CHIP).
rovide public health leadership and coordination across the state for public health issues, including
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disaster preparedness and response.
Collect, maintain, analyze and report health information about vital records, health status and
health care in Texas.
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Overview
DADS
The Texas Department of Aging and Disability Services (DADS) was created to administer long-term
services and supports to people who are older, to people with physical disabilities and to people with
intellectual and developmental disabilities. DADS also licenses and regulates providers of these services
and administers the state’s guardianship program. DADS began formal operations on Sept. 1, 2004.
Vision
Texans who are older and people with disabilities will be supported by a comprehensive and
cost-effective service delivery system that promotes and enhances individual well-being, dignity
and choice.
Mission
To provide a comprehensive array of aging and disability services, supports, and opportunities
that are easily accessed in local communities.
Our key responsibilities to the citizens of Texas include:
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Working in partnership with individuals, caregivers, service providers and other stakeholders.
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Developing and improving service options that are responsive to individual needs and preferences.
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Ensuring and protecting self-determination, individual rights and safety.
Strategic Planning and Budgeting Goals
FY 2013 – 14
Goal 1 – Long-term Services and Supports
To enable Texans who are older and those with disabilities to live dignified, independent and productive
lives in a safe living environment through an accessible, locally based, comprehensive and coordinated
continuum of services and opportunities; to provide appropriate services and supports based on
individual needs, ranging from in-home and community-based services for those who are older or who
have disabilities and request help maintaining their independence and increasing their quality of life, to
institutional services for those who require that level of support, seeking to ensure health and safety and
to maintain maximum independence for the recipient while providing necessary services and supports.
Goal 2 – Regulation, Certification and Outreach
Provide licensing, certification, contract enrollment services, financial monitoring and complaint
investigation to ensure that residential facilities, home and community support services agencies
and people providing services in facilities or home settings comply with state and federal standards, and
that people receive high-quality services and are protected from abuse, neglect and exploitation.
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Section I
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Goal 3 – Indirect Administration
Overview
Assure the efficient, quality and effective administration
of services provided to people who are older and those
with disabilities.
Guiding Principles
The following principles guide DADS daily operations:
Customer Focus – The individual needs, preferences and
rights of those served by DADS are key to the design,
development and implementation of all programs and
service delivery systems.
Accountability – DADS provides good stewardship
of public resources and has systems to measure
performance and allow for accountability to those
we serve, the Legislature, other stakeholders and the
general public.
Best Business Decision – DADS strives to evaluate all
available options and costs in light of its guiding principles to make the best business decisions, while
balancing customer priorities, best practices, standards of excellence and budgetary constraints.
Integrity – DADS staff adhere to a code of professionalism based on integrity and ethical behavior
in all internal and external communications and daily operations. DADS maintains an ethical
environment, which includes the use of high standards, sound judgment and discretion in the
decision-making process.
Continual Improvement – DADS is committed to achieving excellence in everything we do. Continual
improvement is expected in all agency operations, activities and services. DADS will develop and
implement innovative ideas, measure performance and evaluate results to continually improve.
Teamwork and Partnerships – DADS collaborates with individuals, advocates, other federal and state
agencies, elected officials and the general public to achieve positive results. Employees will foster a
teamwork environment both within and outside the agency.
Respect – DADS staff honor the value, dignity, privacy and individuality of DADS staff members and the
individuals we serve.
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DADS Organizational Structure
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DADS is under the leadership of Commissioner Jon Weizenbaum, who has been appointed by the
executive commissioner of the Texas Health and Human Services Commission with the approval
of the governor.
DADS
The agency is divided into the following program and support divisions that report
to the commissioner:
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Office of the Deputy Commissioner
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Office of the Associate Commissioner
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Internal Audit
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Legal Services
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Office of the Chief Operating Officer
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Office of the Chief Financial Officer
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Access and Intake
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Regulatory Services
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State Supported Living Centers
For contact information, see page 110.
The Deputy Commissioner oversees the Center for Policy and Innovation, the Center for Consumer and
External Affairs and the office of the Texas Long-term Care Ombudsman. The Deputy Commissioner
also oversees the Promoting Independence initiative.
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e Center for Policy and Innovation develops, coordinates and directs policy initiatives in longTh
term services and supports. It also includes the Quality Reporting unit and the Quality Monitoring
program, as well as other staff who conduct research and analysis and support agency councils, such
as the Texas Council on Autism and Pervasive Developmental Disorders and the Aging Texas Well
Advisory Committee.
e Center for Consumer and External Affairs coordinates and ensures timely and effective external
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communications to a variety of stakeholders, including legislators, consumers, provider organizations
and associations, and the media. Stakeholder Relations, Media Relations, Government Relations, the
Communications Office and Volunteer and Community Engagement are the units in the Center for
Consumer and External Affairs.
e Texas Long-term Care Ombudsman Program advocates for quality of life and care for nursing
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home and assisted living facility residents. Federal and state authority mandates ombudsmen to
identify, investigate and resolve complaints made by, or on behalf of, people living in nursing facilities
and assisted living facilities and to provide services to help in protecting their health, safety, welfare
and rights. Information and assistance in choosing the most appropriate living residence is also a
valuable service.
Internal Audit is an independent, objective assurance and consulting activity designed to add value and
improve DADS operations. It helps DADS accomplish its objectives by bringing a systematic, disciplined
approach to evaluate and improve the effectiveness of risk management, control and governance
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Section I
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processes. This provides assurance that DADS
is operating in the most effective and efficient
manner possible, is complying with written
policies, procedures, laws and regulations, is
properly safeguarding assets and is complying
with contracts and achieving fiscal integrity.
Internal Audit reports directly to the
commissioner to ensure independence.
Overview
Legal Services provides legal support to all
program and support divisions of DADS
and is made up of four units — Enforcement
Services, Administrative Services, Litigation
Services, and Policy and Rules.
The Chief Operating Officer (COO) oversees
Consumer Rights and Services, Information Technology, Contract Oversight and Support, and
Executive and Staff Operations. The COO is also responsible for some program and service-related
administrative support activities and for coordination with HHSC to ensure the effective and efficient
delivery of administrative support services to other health and human service departments. The COO
division includes the four following sections:
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onsumer Rights and Services is responsible for Consumer Rights / Surrogate Decision Making
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programs, Complaint Intake and Professional Review. It also tracks DADS suspected provider fraud
referrals to the HHSC Office of the Inspector General and resulting investigations of the Office of
the Attorney General.
I nformation Technology (IT) is responsible for the DADS IT Security Office, IT Project Management
Office, Application Management, Infrastructure Operations and Business Operations, including
Customer Service, Technology Goods and Services, and IT Planning, Budget and Accounting.
ontract Oversight and Support is responsible for Contract Review and Technical Assistance, Contract
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Sanctions Review and Nursing Facility Trust Fund Monitoring.
xecutive and Staff Operations is responsible for Administrative Management Services, Educational
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Services and Support Services Coordination, including preparing and maintaining the agency’s
business continuity and emergency response plans and coordinating the agency’s response to
emergencies that can affect essential functions.
The Chief Financial Officer is responsible for Budget and Data Management, Accounting and Claims
Management. Specific responsibilities include:
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Preparing the agency’s biennial Legislative Appropriations Request.
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Preparing fiscal notes and analyzing the financial effect of proposed legislation.
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Preparing, managing and overseeing the development of DADS annual operating budget.
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Managing the daily budget function within DADS.
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Preparing analyses describing the fiscal effect of new or changed rules.
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Conducting work measurement studies to determine the resources needed to deliver services.
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DADS
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alidating, recording and processing payments to vendors, consumers and providers for goods and
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services rendered on behalf of DADS.
alidating, recording and processing payments to reimburse traveling DADS staff and vendors for
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direct billing for travel.
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Recording and processing requisition requests.
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Recording and tracking all DADS capitalized, controlled or leased assets and inventory.
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anaging, processing and recording daily cash flow and ensuring cash or its equivalent is tracked and
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deposited to the appropriate account of the state treasury.
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Ensuring accurate collections from over-payment of Long-Term Care (LTC) Medicaid services.
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Ensuring proper recoupment of denied payments for new LTC admissions.
Access and Intake (A&I) – The assistant commissioner for Access and Intake is responsible for contracting
and oversight for community services and for initiatives carried out within the A&I division. The
division includes area agencies on aging (AAA), local authorities, community services and program
operations (CSPO), community services contracts, guardianship services, strategic operations and
grants, and utilization management and review (UMR).
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ere are 28 AAAs across the state that provide access and assistance services and contract with
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service providers to deliver nutrition, in-home services, transportation and other support services,
including services specifically targeted for informal caregivers. This section ensures compliance with
the Older Americans Act federal programs.
ere are 39 local intellectual and developmental disability authorities (LIDDAs) across the state that
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provide community-based services for people with an intellectual or developmental disability. LIDDAs
help consumers and families access Medicaid-funded services — primarily community intermediate
care facilities (ICFs), Home and Community-based Services (HCS) and Texas Home Living (TxHmL)
Waiver services when capacity is made available; state supported living centers; nursing facilities
through the preadmission screening and resident review (PASRR) process; and other available services
and supports.
ere are 11 community services regions across the state that provide access and assistance for
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community services programs administered by DADS. These programs include community care
services for older Texans and those with disabilities to support independent living in the community
and as an alternative to institutional care in nursing facilities.
e community services contracts section contracts with and oversees community services providers.
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The array of community services includes Medicaid state plan services — Primary Home Care,
Community Attendant Services, Day Activity and Health Services; and Medicaid 1915(c) waivers —
HCS, Community Living Assistance and Support Services (CLASS), TxHmL, Medically Dependent
Children Program (MDCP) and the Deaf Blind with Multiple Disabilities (DBMD) program.
e Guardianship Services program provides guardianship services to people referred by the Texas
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Department of Family and Protective Services, or by a court under limited circumstances as described
in the Estates Code. A guardian is a court-appointed person or entity charged with making decisions
Section I
Overview
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for someone with diminished capacity. Guardianship may include, but is not limited to, overseeing
services, arranging for community or institutional placement, managing estates and making
medical decisions.
e Strategic Operations and Grants section administers multiple and varied programs and services.
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The section oversees the 22 contracted aging and disability resource centers (ADRCs), the Texas
Lifespan Respite Care Program (TLRCP), the Foster Grandparent Program (FGP), additional
community services grants, the Medicaid Estate Recovery Program and Consumer Directed
Services Operations.
Regulatory Services – The assistant commissioner for Regulatory Services is responsible for professional
licensing and credentialing operations, survey operations and enforcement operations.
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rofessional licensing and credentialing operations is responsible for technical and professional review
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of licensing and credentialing facility, agency and individual long-term care service providers.
S urvey operations is responsible for administration of local survey operations, policy development and
support, and compliance, oversight and analysis.
nforcement operations is responsible for provider licensing enforcement, professional credentialing
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enforcement and survey and certification enforcement.
State Supported Living Centers – The assistant commissioner for state supported living centers is
responsible for the operation of Texas’ state-run residential facilities for people with intellectual and
developmental disabilities. The 81st Texas Legislature authorized the creation of this new division, which
provides campus-based direct services and supports to people with intellectual and developmental
disabilities at 13 locations — Abilene, Austin, Brenham, Corpus Christi, Denton, El Paso, Lubbock,
Lufkin, Mexia, Richmond, Rio Grande, San Angelo and San Antonio.
State office operations provide coordination and support to state supported living centers in the areas
of medical, nursing, behavioral, habilitation, dental, pharmacy, physical and nutritional management,
community placement, living options, quality assurance, policy and rules, budget, contracts,
government and media relations, staff resources, training and special projects.
To comply with a 2009 settlement agreement with the U.S. Department of Justice, state supported living
center staff, along with state office staff, continue to initiate or revise statewide and facility-specific
improvement plans for services and supports that includes protection from harm, behavioral health,
medical, dental, nursing, safe medication practices, Physical and nutritional management, physical and
occupational therapy, transition of residents seeking more integrated community residential services,
skills and training programs, consent, record-keeping and communication.
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SSLCs
Information
Technology
Executive and
Staff Operations
Operations
Eugenia Andrew
Area Agencies
on Aging
Anthony
Jalomo
Accounting
Paula Reed
Wes Yeager
Clinical
Innovation
Quality Monitoring
Program
Community
Services Contracts
Utilization
Management and
Review
Cindy
Kenneally
Guardianship
Services
Rosa
Beruman
Enforcement
Services
Ryan Bane
Assistant Commissioner
Access and Intake
Elisa J. Garza
Lisa Glenn, M.D.
Tara Olah
Special Policy
Projects
Administrative
Services
Shelley Janda
Survey
Operations
Linda
Lothringer
Marianne
Reat
Litigation Services
General Counsel
Lawrence Hornsby
Senior Policy
Analyst/Rules
Coordinator
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Enforcement
VACANT
Policy and
Rules
Policy Rules
and Curriculum
Development
Calvin Green
Licensing and
Credentialing
Cindy
Bourland
Assistant Commissioner
Regulatory Services
Jennifer
Chancellor
Quality Reporting
and Research
Mary T. Henderson
Corliss Powell
Nancy Porter
Delia Villarreal
Program Initiatives
and Grants
Donnie Wilson
Business and Contracts
Coordinator
Quality Reporting
and Research
Bonnie Harvey
Center for Policy
and Innovation
State Long-term Care
Ombudsman
Michelle
Dionne-Vahalik
S. Michelle Martin
Patty Ducayet
Kristi Jordan
Deputy Commissioner
Bill Campbell
Provider Claims
Mine Epps
Media
Relations
Cecilia Cavuto
Strategic Operations
and Grants
Local Intellectual
and Developmental
Disability Authorities
Community Services
and Program
Operations
Lisa AkersOwen
Budget
VACANT
Chief Financial
Officer
David Cook
Government
Relations
Cindy
Nottingham
Jeffrey Peck
Communications
Office
Center for Consumer
and External Affairs
Allison Lowery
Holly Riley
Volunteer and
Community
Engagement
Sue Fielder
Scott Schalchlin
Assistant Commissioner for State
Supported Living Centers
Glen Bason
Contract Oversight
and Support
Consumer Rights
and Services
Heather Hall
Kathie
Carleton-Morales
12 Facilities
Shareen
Addison
Chief Operating
Officer
Lynn W. Blackmore
Office of the Independent Ombudsman
George Bithos
Internal Audit
Penny
Rychetsky
DADS Council
Commissioner
Jon Weizenbaum
DADS
Organizational Chart
GOAL 1: Long-term Services and Supports
Intake, Acces, and Elgibility to Services and Supports
Guardianship
Primary Home Care (PHC)
Community Attendant Services (CAS)
Day Activity and Health Services (DAHS)
Community Based Alternatives (CBA)
Home and Community-based Services (HCS)
Community Living Assistance
and Support Services (CLASS)
Deaf Blind with Multiple Disabilities (DBMD)
Medically Dependent Children Program (MDCP)
Texas Home Living Waiver (TxHmL)
Non-Medicaid Services
ID Community Services
Promoting Independence through Outreach,
Awareness, and Relocation
In-Home and Family Support ñ Community
Services (IHFS)
Program of All-Inclusive Care for the Elderly (PACE)
Nursing Facility Payments
Medicare Skilled Nursing Facility
Hospice
Promoting Independence
by Providing Community-based Client Services
Intermediate Care Facilities ñ ID
State Supported Living Centers Services
Capital Repairs and Renovations
Overview
Goal / Strategy
FY2014FY2015
Estimated Estimated Estimated Estimated
State Total State
Total
Expenditures
Expenditures
Expenditures
Expenditures
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Section I
DADS Budget Summary
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128,030,120
261,482,105
850,7797,846,002
6,419,038
16,087,815
240,899,863
610,360,783
3,140,267
7,870,343
0
0
375,125,439
949,401,852
141,789,198
295,565,317
1,559,289 8,554,512
7,080,420
16,546,904
278,448,770
650,733,279
3,366,050
7,866,440
0
0
453,702,779
1,081,459,402
87,448,516
3,656,775
14,851,074
24,031,393
17,499,843
34,252,184
222,909,275
9,288,766
37,220,737
60,788,856
149,893,305
34,254,162
95,966,690
5,444,792
18,846,225
35,965,725
25,720,832
40,398,920
250,497,234
13,548,337
44,114,365
86,127,600
155,375,480
40,401,920
2,213,698
3,661,537
2,713,698
4,161,537
4,989,908
4,989,908
14,969,767
37,518,212
570,039,744
1,354,379,356
43,059,970
102,768,425
107,586,128256,768,802
4,989,907
4,989,907
18,980,869
44,430,595
126,265,448
287,927,194
29,205,261
68,252,537
115,398,636 269,685,991
21,433,436
113,092,104
288,492,614
19,277,327
53,717,884
270,192,080
685,750,833
30,605,271
22,462,249
122,272,376
301,677,299
12,858,494
52,494,154
285,810,626
704,402,956
25,804,168
2,121,359,987
5,167,756,309
1,865,113,927
4,398,750,455
n GOAL 2: Regulation, Certification and Outreach
Facility and Community-based Regulation
21,600,141
Credentialing / Certification
890,768
Long-term Services and Supports Quality Outreach 2,103,177
68,295,519
1,326,683
4,395,839
24,143,978
937,930
2,082,362
74,759,080
1,377,199
7,540,119
GOAL 1 Total
Goal 2 Total 24,594,086
74,018,041
7,164,270
83,676,398
GOAL 3: Indirect Administration
Central Administration Information Technology Program Support 15,925,675
33,586,717
37,534,320
76,712,598
17,215,650
30,164,575
41,510,292
68,883,301
Goal 3 Total
49,512,392
114,246,918
47,380,225
110,393,593
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Grand Total
2,195,466,4655,356,021,268
1,939,658,422 4,592,820,446
Data Source : DADS Operating Budget FY 2016
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DADS Staffing Summary DADS
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Goal / Strategy
FY2015FY2016
Estimated Estimated
Number of Number of
Positions
Positions
n GOAL 1: Long-term Services and Supports
Intake, Access, and Eligibility to Supports and Services
Guardianship
Community-based Alternatives (CBA)
Community Living Assistance and Support Services (CLASS)
Texas Home Living Waiver (TxHmL)
ID Community Services
Promoting Independence through Outreach, Awareness, and Relocation
In-Home and Family Support - (IHFS)
Program of All-Inclusive Care for the Elderly (PACE) 0.0
Medicare Skilled Nursing Facility
Hospice
Promoting Independence by Providing Community-based Client Services Intermediate Care Facilities
State Supported Living Centers Services
Balancing Incentive Program
1,207.1
1,320.5
114.6125.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.00.0
0.0
0.0
30.9
32.0
12,474.5
13,598.1
0.0
0.0
0.0
0.0
Goal 1 Total
13,827.1
15,075.6
GOAL 2: Regulation, Certification and Outreach
Long-term Services and Supports Quality Outreach
1,062.9
27.3
59.0
1,144.0
28.0
64.0
Goal 2 Total
1,149.2
1,236.0
GOAL 3: Regulation, Certification and Outreach
Central Administration
Information Technology Program Support
419.5
133.3
444.0
119.2
Goal 3 Total
552.8
563.2
Grand Total
15,529.1
16,874.8
n
n
Data Source: DADS Operating Budget FY2016
16
Section II.
Programs
and Services
19
Intake, Access, and Eligibility
D
DADS
l
ADS provides functional and financial eligibility
determination, development of service plans based on
individual needs and preferences, assistance in obtaining
information and authorization of appropriate services
and supports through effective and efficient management
of DADS staff.
DADS provides these services through:
l Community services (CS).
l Regional staff located in offices around the state.
l Contracts with local area agencies on aging (AAA)
and local intellectual and developmental disability
authorities (LIDDAs).
DADS CS regional staff determine functional eligibility for Title XIX, and functional and financial
eligibility for Title XX and general revenue-funded community services and supports programs to allow
people to remain in the most integrated community settings, and delay or prevent institutionalization.
LIDDAs determine eligibility for general revenue funded services and help consumers with an intellectual
or developmental disability access appropriate services and supports.
AAAs help older people, their family members or other caregivers by providing information, referrals
and assistance in accessing services and supports. The AAAs are also part of the State Health Insurance
Assistance Program (SHIP) in Texas, a national program funded by the Centers for Medicare &
Medicaid Services (CMS). Through legal assistance services, AAAs provide information, counseling
and assistance to Medicare beneficiaries and/or their representatives about Medicare, Medicaid, public
benefits, entitlements and other types of health insurance.
Aging and disability resource centers (ADRCs) serve as highly visible, trusted resources for assistance with
access to the full range of community-based long-term services and supports (LTSS) options via a no
wrong door model for all individuals regardless of age, income and disability. DADS contracts with 22
ADRCs to provide assistance to individuals and caregivers across the state.
The utilization management and review (UMR) section is responsible for utilization review activities
in DADS 1915(c) waiver programs, the hospice program and community entitlement programs to
ensure services are the most appropriate and cost-effective. This section performs program enrollment
activities, which include ongoing work with people and providers in the Home and Community-based
Services (HCS), the Texas Home Living (TxHmL), the Community Living Assistance and Support
Services (CLASS) and the Deaf Blind with Multiple Disabilities waiver programs. Additionally,
UMR manages provider transfers, individual suspensions, program terminations and fair hearing
representation in the IDD waiver programs, as well as level of need reviews in HCS and TxHmL
programs. The area performs eligibility reviews and level of need provider cost increase requests for
the intermediate care facility (ICF) program. The UMR section conducts desk reviews and face-to-face
reviews to determine that recipients are getting the services they need — no more, no less. Lastly, this
section determines levels of care for individuals with intellectual or developmental disabilities who wish
to receive Community First Choice services and are not enrolled in a 1915(c) waiver program.
18
Section II
Intake, Access, and Eligibility for Services and Supports
l
Programs and Services
Community Services and Program Operations (CSPO)
DADS community services staff, managed by the CSPO section in the Access and Intake division,
administers community services programs in 11 regions. Staff determine functional and financial
eligibility and enroll eligible people in the community service programs, which include:
n
Title XX programs
– Residential Care (RC)
– Home-delivered meals (HDM)
– Emergency Response Service (ERS)
– Adult Foster Care (AFC)
– Family Care (FC)
– Day Activity and Health Services (DAHS)
– Consumer Managed Personal Attendant Services (CMPAS)
– Special Services to Persons with Disabilities (SSPD)
– 24-Hour Shared Attendant Care (SSPD-SAC)
n
The general revenue-funded program
– In-home and Family Support Program (IHFSP)
n
Medicaid entitlement programs
– Primary Home Care (PHC)
– Community Attendant Services (CAS)
– Day Activity and Health Services (DAHS)
Staff also determine the functional capabilities of children who would be eligible for Medicaid-funded
nursing facility care but choose to live in the community.
n Th
e
community services waiver program covered under this function is the Medically Dependent
Children Program (MDCP).
CSPO section staff also oversee the Medicaid Hospice Program policy and the Program of All-inclusive
Care for the Elderly (PACE) located in El Paso, Amarillo/Canyon and Lubbock. DADS announced
tentative awards for three new PACE sites in the Dallas, western San Antonio and Houston areas.
Funding for many community programs or services is limited, and this affects how many people can
receive them. Consequently, the names of those interested in applying for these programs or services
are placed on the appropriate interest lists.
Eligibility Requirements
Eligibility for some CS programs requires a functional assessment score be determined through an
assessment completed by DADS staff (see appendices for description of this assessment process).
Applicants for most programs must have appropriate financial categorical status or meet the DADS
income and resource guidelines. Other programs determine functional eligibility through an assessment
of non-financial, program-specific criteria. The MDCP and PACE programs require that those receiving
services have a medical necessity for eligibility, along with meeting the financial eligibility requirements
of the respective programs. In PACE, contractors conduct the medical necessity assessments.
— Statutory Authority. Social Security Act Titles XIX and XX [42 U.S. C. §§ 1396-1396w-2; §§ 13971397f]; Texas Human Resources Code chapters 32 and 35 and § 161.071(1).
19
Local Intellectual and Developmental Disability Authorities (LIDDAs)
DADS
l
DADS is the state agency responsible for oversight of the publicly funded intellectual and developmental
disability (IDD) service delivery system in Texas. Each county in Texas is served by one of 39 LIDDAs,
which provide general revenue services directly or through a network of local providers. LIDDAs
provide intellectual and developmental disability services to members of the priority population living
in counties they serve. LIDDAs help consumers get appropriate services and supports. The mix of
services delivered at the local level varies, with each LIDDA identifying service needs and priorities for
the service area through a local planning process.
Services include:
l
l
ligibility determination, which determines if a person has an intellectual disability or related
E
condition and is a member of the intellectual and developmental disability priority population.
S ervice coordination, which is help in accessing medical, social, educational and other appropriate
services and supports to help them maintain or improve their quality of life and to remain within
their chosen community.
LIDDAs are also responsible for:
l
l
l
l
elping enroll people in the Intermediate Care Facilities (ICF) program, including state supported
H
living centers (SSLC), and the Home and Community-based Services (HCS) and Texas Home Living
(TxHmL) Medicaid waiver programs.
onducting permanency planning for children under the age of 22 who live in an ICF or residential
C
setting of the HCS program.
onducting the annual community living options information process (CLOIP) for all adults living
C
in state supported living centers.
onducting Preadmission Screening and Resident Review (PASRR) for people residing in or being
C
admitted to a nursing facility, including evaluating whether people being admitted to a nursing facility
have IDD and if so, assigning a service coordinator to ensure they receive:
– Needed specialized services through the LIDDA and nursing facility.
– Alternate placement services if requested.
DADS oversees community programs and services delivered through contracts with the LIDDA.
Oversight ensures recipients of community services are provided quality services appropriate to their
needs and preferences and that services are provided effectively and efficiently. DADS also ensures that
LIDDAs have systems to fulfill responsibilities delegated to them by the state authority. Oversight also
includes ensuring LIDDAs fulfill their contracts with DADS and are operating in compliance with state
law and DADS rules.
DADS uses a variety of methods to fulfill its oversight responsibility, including:
20
l
Monitoring data related to service delivery and fiscal monitoring.
l
Promulgating rules for compliance.
l
Interviewing service recipients and their families during on-site visits.
l
Interviewing providers of services and administrators.
l
Reviewing service records and administrative documentation.
Section II
l
Health and Safety Code § 550.0355 includes a provision limiting the
number of people a LIDDA may serve in its HCS waiver program. The
provision reflects a negotiated agreement between representatives of the
LIDDAs and private providers. The bill also required the adoption of
rules governing the role and responsibilities of a LIDDA. The rules took
effect on Dec. 1, 2008.
All members of the DADS IDD priority population.
— Statutory Authority. Texas Health & Safety Code §§ 533.035 and 533.0355;
Texas Human Resources Code § 161.071(1) and (3).
— Rules. Title 40 TAC. Chapter 2; and Chapter 4, Subchapters C, K and L.
Area Agencies on Aging (AAA)
The Access and Intake Division, in collaboration with the 28 AAAs under
contract with DADS, supports a comprehensive system of access to
information and resources, as well as help coordinating and arranging
for services to people 60 and older, as mandated under the Older
Americans Act (OAA). Access and assistance services include:
I nformation, referral and assistance.
Care coordination.
l Caregiver support coordination.
l B enefits counseling (legal assistance and legal awareness).
l Caregiver education and training.
l Caregiver information services.
l Caregiver respite services.
l Advocacy for residents of nursing homes and assisted living facilities through the Long-term
Care Ombudsman Program.
l
l
The National Family Caregiver Support Program (NFCSP)
Authorized by the OAA amendments of 2006, the NFCSP provides critical supports to help families
maintain their caregiver roles. Under this program, a family caregiver is defined as an adult family
member or other person who is an informal provider of in-home and community care to:
l An aging person
l Someone with Alzheimer’s disease or a related disorder with neurological and organic
brain dysfunction.
l A grandparent or step-grandparent of a child.
l A relative of a child by blood, marriage or adoption who is 55 or older.
l Someone who cares for a child 18 or younger or an adult aged 18-59 with a disability.
Through the NFCSP, the AAAs support caregivers under most service categories. Implementation
of the 2006 OAA reauthorization established priority populations for a caregiver who is caring for an
aging person with Alzheimer’s disease or a related disorder, and a grandparent or relative caregiver
caring for a child.
21
DADS
l
Access and assistance services
Access and assistance services provided by the AAA (directly
and through contracts) help older people, their family members
or other caregivers get the information and assistance they
need in obtaining community services, both public and private,
formal and informal.
The needs identified for an older person may include a
wide range of support services, including assistance with
transportation to congregate meal sites or to medical
appointments, homemaker or personal care services in
the home, help with prescription drugs, and emergency
response systems.
Access and assistance services include:
l Information, referral and assistance – Assessing consumers’ needs, finding organizations capable of
meeting those needs, evaluating all appropriate resources, providing enough information about each
resource to help consumers make informed choices, helping consumers find alternative resources,
actively linking people to needed services and performing follow-up to ensure the services are
provided.
l
l
l
l
l
22
enefits counseling/legal assistance – AAA staff and volunteers in the benefits counseling program
B
are certified to help older people gain information about public benefits, private benefits and a variety
of community programs. Benefits counseling services include helping older people and Medicare
beneficiaries or their representative(s) with understanding their rights, applying for benefits, receiving
appropriate referrals, exercising choice, benefiting from services and opportunities authorized by law
and maintaining their rights, especially the rights of those with reduced capacities. Consumer-fraud
protection issues are a major theme in a benefits counselor’s work, along with basic information about
rights, benefits and entitlements. Legal assistance activities provided by the AAA are counseling,
document preparation and representation. Assistance with other issues, such as money management,
representative payee and guardianship (local service providers, not DADS guardianship services) and
accessing resources for those issues, are also provided as needed.
enefits counseling/legal awareness – The dissemination of accurate, timely and relevant information,
B
eligibility criteria, requirements and procedures for older people about public entitlements, health/
long-term care services, individual rights, planning/protection options, housing and consumer issues
in a group setting.
are coordination – An ongoing process to assess the needs of older people and effectively arrange,
C
coordinate and follow up on services that most appropriately meet the needs as defined by the
recipient, access and assistance staff and, where appropriate, a family member or other caregiver(s).
aregiver support coordination – Assessing the needs of a caregiver and care recipient, effectively
C
planning, arranging, coordinating and following up on services that most appropriately meet the
identified needs as mutually defined by the caregiver, the recipient and access and assistance staff.
aregiver education and training – Counseling for caregivers to help them make decisions and solve
C
problems related to their caregiver roles, including counseling, support groups and caregiver training
for individual caregivers and families.
aregiver information services – The dissemination
C
of accurate, timely and relevant information for
informal caregivers, grandparents or relatives caring
for children 18 and younger, as well as the public,
through publications, large group presentations,
seminars, health fairs and mass media. Developing
a resource library and other resources for use in
the dissemination of caregiver information is a
component of this service.
l
l
Section II
l
Long-term Care (LTC) Ombudsman Program –
542 volunteers and 71 full-time equivalent staff serve
as certified LTC ombudsmen across Texas. LTC
ombudsmen are advocates for residents of nursing
facilities and assisted living facilities. The Office of the
State LTC Ombudsman administers statewide ombudsman operations, which are provided directly by
a AAA, or by contract with a local organization. The LTC Ombudsman Program provides services to
protect the health, safety, welfare and rights of residents. Services include complaint resolution by an
LTC ombudsman, who represents the residents’ interests to the management of the facility. Advocacy
activities also include development of resident and family councils, as well as education for LTC facility
staff and community organizations. Education sessions focus on topics such as resident rights, longterm care ombudsman services, resident-directed care, recognizing elder abuse and neglect, and how to
select a care facility. To resolve problems, the program coordinates with other programs and agencies,
such as DADS Regulatory Services, Texas Legal Services Center, Texas Adult Protective Services,
LIDDAs, centers for independent living, city and county governments and local health and service
organizations. LTC ombudsmen also protect residents’ rights by advocating for change in policy, rule
and law.
Eligibility Requirements.
Services are provided for people 60 and older and are targeted to those with greatest economic and
social need. Emphasis is on providing services to older people with low income who are members of
minority groups, older people with limited English proficiency and older people living in rural areas.
Additionally, family members or other caregivers may receive information and services on behalf of the
older people for whom they are providing care. Services may also be provided to certain caregivers who
are under age 60, as described in the National Family Caregiver Support Program section above.
— Statutory Authority. Older Americans Act of 1965 [42 U.S.C. chapter 35]; Texas Government Code
§ 531.02481(e); Texas Human Resources Code §§ 101.022(d), 101.025, 101.030 and 161.071(5)(A).
— Rules. 45 C.F.R. part 1321; 40 T.A.C. chapters, 81, 83 and 85.
Strategic Operations and Grants
The Access and Intake Division, through the Strategic Operations and Grants section, administers
programs and innovative grant projects that promote streamlined access to community-based longterm services and supports for eligible Texans and their caregivers. The section oversees three programs
providing community services: the Aging and Disability Resource Center (ADRC) Program, the Texas
Lifespan Respite Care Program (TLRCP) and the Foster Grandparent Program (FGP). The section also
oversees the Medicaid Estate Recovery Program and Consumer Directed Services operations.
23
DADS
l
Aging and Disability Resource Centers (ADRCs)
ADRCs serve as a key point of access to person-centered long-term services and supports (LTSS)
information, referrals and assistance. Through strong community partnerships fostered by the ADRCs,
all individuals and caregivers, regardless of age, income and disability will receive information about
options for private and public community-based LTSS. ADRCs provide:
l Access to Services (Information/Referral and Screening) – Support accessing an array of private and
public LTSS, including through the use of a screening tool launched in August 2015 to help individuals
and caregivers identify LTSS options
l Transition Planning or Person-Centered Options Counseling – Assistance for non-Medicaid nursing
facility residents transitioning into the community
l Housing Navigation – Education and assistance for key stakeholders such as housing authorities,
property owners, and developers about providing additional affordable, accessible housing
l Other Local Services – Support for a range of other pilot programs or local initiatives — often related
to housing, transportation and healthcare services — aimed at benefiting individuals with LTSS needs.
For more information about ADRCs or to find an ADRC in your area, please visit the ADRC website
at www.dads.state.tx.us/care or call 855-937-2372 and enter your ZIP code to be automatically
connected to the ADRC in your area.
Texas Lifespan Respite Care Program (TLRCP)
The TLRCP supports family and informal caregivers by increasing awareness and the availability of
respite services.
The TLRCP provides information and resources to support caregivers through the Take Time Texas
website www.dads.state.tx.us/taketimetexas, which is the state’s only comprehensive, searchable database
of Texas respite care providers.
The program provides short-term respite care to allow family caregivers a brief period of relief or
rest so they can recharge and continue their caregiving duties. These services are designed to assist
caregivers who do not qualify for, or cannot access, respite from other sources. DADS funds community
organizations to conduct and coordinate TLRCP respite services for their local areas.
Foster Grandparent Program
The Foster Grandparent Program is administered by the Corporation for National and Community
Service (www.seniorcorps.org) and hosted by DADS. Since 1965, the DADS Foster Grandparent
Program has paired older adult volunteers with children and youth who have exceptional or special
needs. Foster grandparents volunteer 15-40 hours per week (five days per week, four to eight hours
per day) to provide consistency to the youth of the state.
Medicaid Estate Recovery Program (MERP)
In 1993, the federal government enacted legislation that required each state to develop a Medicaid Estate
Recovery Program. The federal law requires state Medicaid programs to recover a portion of the money
spent on services provided to long-term care Medicaid recipients. The enabling federal legislation sets
forth certain mandatory requirements but also provides the states with local decision-making authority
in how their recovery program is implemented.
MERP was written into Texas law as part of House Bill 2292, 78th Legislature, Regular Session, 2003.
As the state’s Medicaid agency, the Texas Health and Human Services Commission (HHSC) was
responsible for developing the program requirements. The MERP rule was finalized in the Texas
Administrative Code in December 2004.
24
Section II
l
The Texas MERP implementation date was March 1, 2005. At that time, HHSC delegated operation of
the program to the DADS Access and Intake division. A contract for the claims-filing component of the
program was awarded to a private entity through a competitive procurement process. The DADS state
office retains responsibility for contract oversight, program policy issues and public educational efforts.
MERP applies only to services provided to people 55 or older who applied for certain LTSS on or after
March 1, 2005, not recipients who applied for these services before March 1, 2005. The following longterm care services are subject to MERP:
l Nursing Facility Care
l Intermediate Care Facility for Persons with ID
l Medicaid 1915(c) waiver programs:4 Community-based Alternatives, Home and Community-based
Services, Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities
Waiver, Consolidated Waiver Program, and the Texas Home Living Waiver, Integrated Care
Management and STAR+PLUS
l Community Attendant Services (a 1929(b) program)
MERP also affects hospital and prescription drug services provided through nursing facility or home
and community-based services.
Although Community Attendant Services (CAS) is subject to MERP, Primary Home Care (PHC) is not
because it is established under a different federal statutory authority.
For more detailed information, go to www.dads.state.tx.us/services/estate_recovery/index.html.
— Statutory Authority. Social Security Act § 1917(b)(1) [42 U.S.C. § 1396p(b)(1)];
Texas Government Code § 531.077.
— Rules. 42 C.F.R. § 433.36; Title 1 TAC. Chapter 373.
Consumer Directed Services (CDS) Operations
CDS is a service delivery option in which an individual receiving services, or his or her legally authorized
representative, serves as the employer and assumes responsibilities such as hiring, training and dismissing
service providers. CDS is based on the philosophy of self-determination. CDS employers must select a
financial management services agency (FMSA) to conduct financial management services such as payroll
and employer taxes. For more information about CDS, please visit www.dads.state.tx.us/providers/cds/.
Statewide Intake, Access, and Eligibility • Statistics
Number of certified ombudsmen Number of people receiving care coordination Statewide average cost per care coordination recipient Number of people receiving legal assistance
Statewide average cost per person receiving legal assistance
FY 2014
FY 2015
716 816
15,627
16,884
$224.23
$232.07
25,872
24,941
$121.06
$129.11
Average monthly number of people with intellectual and developmental
disabilities receiving assessment and service coordination 29,69132,782
Average monthly cost per person with intellectual and developmental
disabilities receiving assessment and service coordination $166.86$169.78
Average number of people eligible per month: Community Services and Supports
106,361
89,818
$40.40
$48.45
Average monthly cost per case: Community Services and Supports
Data Sources: DADS Operating Budget FY16
25
Local Intellectual and Developmental
Disability Authorities (LIDDAs) • Average Served per Month
FY
2015
DADS
l
LIDDAs
Service Target • Average Number of People with ID Receiving
Assessment and Service Coordination per Month
ACCESS Andrews Center
Austin-Travis County Integral Care
Betty Hardwick Center
Alamo Local Authority for Intellectual and Developmental Disabilities
Bluebonnet Trails Community Services
580
1,172
520
2,489
924
Border Region Behavior Health Center
321
Burke Center
584
Camino Real Community Services
385
Center for Life Resources
292
Central Counties Services
570
Central Plains Center
177
Coastal Plains Community Center
236
Community Healthcore
823
Denton County MHMR Center
753
Emergence Health Network
813
Gulf Bend Center
226
Gulf Coast Center
642
Heart of Texas Region MHMR Center
752
Helen Farabee Centers
392
Hill Country Mental Health and Developmental Disabilities Centers
789
Lakes Regional MHMR Center
LifePath Systems
Metrocare Services
MHMR Authority of Brazos Valley
MHMR Authority of Harris County
MHMR Center of Nueces County
MHMR of Tarrant County
1,218
686
2,972
399
4,315
700
2,712
MHMR Services for the Concho Valley
437
Pecan Valley Centers
432
Permian Basin Community Centers
268
Spindletop Center
780
StarCare Specialty Health System
629
Texana Center
1,122
Texas Panhandle Centers
656
Texoma Community Center
210
Tri-County Services
594
Tropical Texas Behavioral Health
West Texas Centers
State Total
Data Sources: Claims Management System Payment Data. DADS Program Areas
26
159
1,334
299
33,360
Section II
Number of Certified
Ombudsman
People Receiving
Care Coordination
People Receiving
Legal Assistance
Alamo Area
31
858
730
Ark-Tex
10225 476
Bexar County
23
1,247
3,109
Brazos Valley
26
52
338
Capital Area
19
545
1,249
Central Texas
34
120
507
Coastal Bend
32
210
609
Concho Valley
10
320
791
Dallas County
56
570
230
Deep East Texas
32
316
537
East Texas
26
515
681
Golden Crescent Region
24
195
575
Harris County
105
3,786
2,412
Heart of Texas
31
612
779
Houston - Galveston
47
608
1,322
Lower Rio Grande Valley
52
1,444
476
Middle Rio Grande
2
139
721
North Central Texas
76
304
725
North Texas
32
227
1,051
Panhandle
16196 750
Permian Basin
10
308
1,028
8
1225
772
Southeast Texas
26
208
405
South Plains
10
234
1,392
South Texas
5
331
828
Tarrant County
40
788
634
Texoma
10
816
1,040
West Central Texas
23
485
774
Rio Grande
Total
FY 2015
Area Agency on Aging
l
Area Agencies on Aging • Statistics
81616,884 24,941
Data Sources: DADS Operating Budget FY 2016
27
Guardianship Services
DADS
l
A guardian is a court-appointed person or entity (such as a state
agency) responsible for making decisions on behalf of someone with
diminished capacity. Title III of the Texas Estates Code defines the
purpose, laws and responsibilities of a guardian. Depending upon
the powers granted by the court, guardianship responsibilities
may include:
l
l
roviding or arranging for services for adults with diminished
P
capacity who otherwise qualify for guardianship services under
Texas law.
rranging for placement in facilities, such as long-term care
A
facilities, hospitals or foster homes.
l
Managing estates.
l
Making medical decisions.
The DADS Guardianship Services Program provides guardianship services, directly or through
contracts with local guardianship programs, to people in need of a guardian who are:
l
l
Referred to the program by the Texas Department of Family and Protective Services.
Referred to the program by courts with probate authority under certain circumstances
outlined in statute.
DADS staff providing guardianship services are required to be certified by the Texas Judicial Branch
Certification Commission.
— Statutory Authority. Human Resources Code §§161.071(10) and 161.101-161.113;
— Rules. Title 40 TAC. Part 1. Chapter 10.
Guardianship Services • Statistics
FY 2014
FY 2015
Average number of people receiving guardianship services from DADS staff 928
914
Average number of wards receiving guardianship services – private guardianship programs 419
410
Average monthly cost per adult guardianship recipient served by DADS staff $539.62 $617.21
Average monthly cost per adult– DADS contractors
$205.79 $218.92
Average monthly cost per adult guardianship recipient $431.80 $492.80
36
32
Average monthly number of referrals from Texas Department of Family and
Protective Services to DADS for assessment/need guardianship
28
Section II
l
Community Services – Medicaid Entitlement
Established in Texas in 1967, Medicaid is a jointly funded state-federal program administered by the
Texas Health and Human Services Commission (HHSC). Some Medicaid programs are entitlement
programs, for which the federal government does not, and a state cannot, limit the number of eligible
enrollees. Everyone who meets eligibility requirements must be served, and Medicaid must pay for any
service included in the Medicaid State Plan.
Community Services entitlement programs are provided for people who are older and those with
disabilities so they may continue to live in the community. Entitlement services include Primary
Home Care (PHC), Community Attendant Services (CAS), Day Activity and Health Services (DAHS)
and Hospice.
People receiving PHC and CAS may choose a provider agency or use the Consumer Directed Services
(CDS) option, which allows the recipient or the recipient’s legally authorized representative (LAR) to
serve as the employer and assume responsibility for screening, hiring, training and dismissing providers.
Those choosing CDS must select a financial management services agency (FMSA) to provide services
such as payroll and employer taxes.
Community First Choice (CFC) is provided to people enrolled in DADS waiver programs serving people
with intellectual and developmental disabilities or related conditions.
Financial eligibility for these programs is determined by HHSC or, if the recipient gets Supplemental
Security Income (SSI), through the Social Security Administration. Functional eligibility is determined
by DADS. See the appendices for a description of the functional needs assessment process.
Community Services • Entitlement Statistics
FY2014 • Monthly Average
Number Percent of
Region
Served
State Total FY2015 • Monthly Average
Number Percent of
Served
State Total
1 Lubbock 1,257
2.00%
1,185
2.10%
670
4.30%
1,524
2.80%
3 Grand Prairie
8,904
14.20%
9,533
17.30%
4 Tyler
4,9387.90%
2,6754.80%
5 Beaumont
2,555
4.10%
2,073
3.80%
110,875
17.40%
10,667
19.30%
7 Austin
5,446
8.70%
3,797
6.90%
8 San Antonio
8,226
13.20%
6,692
12.10%
9 Midland
82,048
3.30%
835
1.50%
10 El Paso
2,604
4.20%
2,559
4.60%
2 Abilene
6 Houston
11 Edinburg
State Total
13,02820.80%
62,551
100.00%
13,64724.70%
55,187
100.00%
Data Source: DADS Operating Budget FY 2016
29
Community Services • Entitlement Statistics DADS
l
FY 2014
FY 2015
Average number served per month
62,551 55,187
Average monthly cost per recipient $ 864.25
$ 949.90
PHC provides attendant services for people with an approved medical need for assistance with personal
care tasks. PHC is available to eligible adults whose health problems cause them to be functionally
limited in performing activities of daily living according to a medical practitioner’s statement of medical
need. Attendants help recipients with activities such as bathing, grooming, meal preparation and
housekeeping. On average, recipients are authorized to receive approximately 16.6 hours of assistance
per week. They may choose a provider agency or use the Consumer Directed Services (CDS) option.
Recipients must:
l B e at least 21 years old.
l B e a full Medicaid recipient.
l Have a monthly income of $733/month per person ($1,100 per couple).
l Have countable resources of no more than $2,000 per person or $3,000 per couple.
l Have a functional assessment score of 24 or greater.
l Have a functional limitation with at least one personal care task based on a medical condition.
l Have a medical practitioner’s statement of medical need.
l Have an unmet need for purchased task(s).
— Statutory Authority. Social Security Act, § §1905(a)(23)[42 U.S.C. § 1396 (d) (23)]; Human Resources Code,
Chapter 32 and § 161.071 (1) and (3).
— Rules. Title 40 TAC. Part 1. Chapter 47 and Chapter 48.
Primary Home Care • Statistics FY 2014
FY 2015
Average number served per month
10,990
1,350
Average monthly cost per recipient $725.75 $971.64
Footnote: Because of the significant expansion of STAR+PLUS in FY 2012 the average number of recipients dropped significantly.
30
Section II
l
Primary Home Care • Monthly Averages
Number Percent of
Region
Served
State Total 1 Lubbock
2 Abilene
4 Tyler
Number Percent of
Served
State Total
172
1.60%
20
1.50%
1,115
10.10%
24
1.8%%
591
5.40%
177
13.1%%
2,167
19.70%
55
4.10%
3 Grand Prairie
5 Beaumont
6135.60%
6 Houston
296
2.70%
158
11.70%
7 Austin
1,696
15.40%
55
4.00%
8 San Antonio
1,745
15.90%
134
9.90%
9 Midland
1,094
10.00%
10
0.80%
10 El Paso
313
2.80%
43
3.20%
11 Edinburg
State Total
1,18810.80%
10,990 100.0% Programs and Services
by Region
292.20%
64347.70%
1,350 100.0%
Data Sources: DADS Operating Budget FY 2016 • Claims Management System Payment Data • DADS Program Areas
Footnote: The significant shifts in regional distribution are the result of STAR+PLUS expansion in FY 2012.
CAS provides attendant services for people with an approved
medical need for assistance with personal care tasks. CAS is
available to eligible adults and children whose health problems
cause them to be functionally limited in performing activities
of daily living according to a medical practitioner’s statement
of medical need. Attendants assist with activities such as bathing,
grooming, meal preparation and housekeeping. On average,
recipients are authorized to receive approximately 16 hours of
assistance per week. They may choose a provider agency or use
the Consumer Directed Services (CDS) option.
Recipients may be any age and must:
l Not be eligible for Medicaid.
l Have a monthly income within 300 percent of the monthly
income limit for SSI ($2,199/month per person, $4,398
per couple).*
31
l
DADS
l
Have countable resources of no more than $2,000 per person or $3,000 per couple.
l
Have a functional assessment score of 24 or greater.
l
Have a medical practitioner’s statement of medical need.
l
Have a functional limitation with at least one personal care task based on a medical condition.
l
Have an unmet need for home management and personal care task(s).
* S SI levels are adjusted at the federal level each year based upon annual changes in the Consumer Price Index.
— Statutory Authority. Social Security Act § 1929(b) [42 U.S.C. § 1396t(b)]; Texas Human Resources Code
§§ 32.061 and 161.071(1) and (3).
— Rules. Title 40 TAC. Part 1. Chapter 47 and Chapter 48.
Community Attendant Services • Monthly Averages
by Region
Number Percent of
Region
Served
1,000
2 Abilene
1,4412.90%
1,5032.90%
3 Grand Prairie
8,364
9,352
4 Tyler
2,3824.80%
2,5854.90%
5 Beaumont
1,9053.80%
2,0633.90%
6 Houston
2.00%
16.80%
10,68621.50%
1,072
2.00%
17.80%
10,54720.00%
7 Austin
3,5407.10%
3,7277.10%
8 San Antonio
5,857
6,244
9 Midland
10 El Paso
11.80%
8231.70%
2,278
4.60%
11.90%
8291.60%
2,511
4.80%
11 Edinburg
11,49123.10%
12,20123.20%
State Total
49,767100.00%
52,634100.00%
32
Number Percent of
Served
State Total
Section II
l
To provide an alternative to placement in a nursing
facility or other institution, licensed adult day care
facilities with a DAHS contract provide daytime
services Monday through Friday to people living in
the community. People who meet Title XX eligibility
guidelines are also eligible. Services address
recipients’ physical, mental, medical and social
needs. Services include:
l
Nursing and personal care.
l
A noontime meal and snacks.
l
Transportation.
l
Social, educational and recreational activities.
Services are provided in three-hour to six-hour units. Recipients may receive a maximum of 10 units
of service per week.
Recipients must be 18 or older and must:
l
Be a full Medicaid recipient. (For people without Medicaid, see Community Services
and Supports – Non-Medicaid section for the Title XX DAHS requirements)
l
Be able to benefit therapeutically from DAHS as determined by a health assessment.
l
Have a functional disability related to the medical diagnosis.
l
Have an unmet need for services and not be eligible for other services that duplicate DAHS.
l
Have prior approval granted by a DADS regional nurse.
l
Have one or more functional limitation.
* People younger than 18 are not ineligible; however, they are not eligible to participate in DAHS
in a licensed adult day care facility due to state licensure limitations.
— Statutory Authority. Social Security Act § 1905(a)(13) [42 U.S.C. § 1396(d)(13)]; Texas Human Resources Code
Chapter 32 and § 161.071(1) and (3).
— Rules. Title 40 TAC. Part 1. Chapter 98, Subchapter H.
Day Activity and Health Services • Statistics
FY 2014
FY 2015
1,794
1,203
$503.53 $545.26
Average number of recipients per month
Average monthly cost per recipient Data Source: DADS Operating Budget FY 2016
33
Day Activity and Health Services • Monthly Averages
by
Region
DADS
l
Number Percent of
Region
Served
94
2 Abilene
321.80%
3 Grand Prairie
54
3.00%
55
4.60%
239
13.30%
44
3.70%
4 Tyler
5.20%
Number Percent of
Served
State Total
104
8.60%%
90.70%
5 Beaumont
130.70%
10.10%
6 Houston
734.10%
574.80%
7 Austin
1196.60%
534.40%
8 San Antonio
613
34.20%
9 Midland
412.30%
10 El Paso
27
11 Edinburg
State Total
1.50%
49027.30%
1,794100.00%
349
29.00%
50.40%
23
1.90%
50441.90%
1,203100.00%
Footnote: The significant shifts in regional distribution are the result of STAR+PLUS expansion in FY 2012.
Community First Choice (CFC)
On June 1, 2015, HHSC and DADS implemented a federal state plan option that allows states to provide
home and community-based attendant services and supports to Medicaid recipients with disabilities.
CFC services are also available to individuals enrolled in DADS Section 1915(c) waiver programs: Home
and Community-based Services Program, Texas Home Living Services Program, the Community Living
Assistance and Support Services Program, and the Deaf Blind with Multiple Disabilities Program.
CFC is delivered by the individual’s waiver program provider.
Services include:
l CFC personal assistance services/habilitation (PAS/HAB), which replaces similar habilitation services
in the four DADS waiver programs. People may use the CDS option for CFC PAS/HAB.
l Emergency response services, which provide back-up systems and supports, including electronic
devices with a backup support plan to ensure continuity of services and supports.
l Support management services, which provide voluntary training on how to select, manage and
dismiss attendants.
Recipients must:
l B e a child or an adult who is eligible for Medicaid.
l Require an institutional level of care (e.g. a nursing facility, an institution for mental disease, or an
intermediate care facility for individuals with an intellectual disability or related condition).
34
Section II
l
Community Services
and Supports
Waiver Programs
Medicaid waiver programs are exceptions to the
usual Medicaid requirements. They are granted
to a state by the Centers for Medicare & Medicaid
Services (CMS), the federal agency responsible
for administering Medicare and overseeing state
administration of Medicaid. Section 1915(c) of
the federal Social Security Act is one section
through which CMS authorizes waiver programs.
Waiver programs provide community-based
services and supports for people who qualify for
admission to a nursing facility or to an intermediate care facility for individuals with intellectual and
developmental disabilities but have made an informed choice to receive waiver services. Waivers are
intended to provide services in the home or in a community setting and to be cost-effective alternatives
to institutional settings. DADS administers five waiver programs and maintains interest lists for the
programs. A person can be enrolled in only one 1915(c) waiver program at a time.
Recipients can choose a provider agency or use the consumer directed services (CDS) option.
The CDS option allows the recipient or a legally authorized representative (LAR) to serve as the
employer and assume responsibility for screening, hiring, training and dismissing providers.
Those who choose the CDS option must select a financial management services agency (FMSA)
to provide financial management services, such as payroll and employer taxes.
Community Services and Supports Waiver Programs
l
Home and Community-based Services
l
Community Living Assistance and Support Services
l
Deaf Blind with Multiple Disabilities
l
Medically Dependent Children Program
l
Texas Home Living
35
DADS
l
The HCS program provides services and supports for people with
intellectual and developmental disabilities as an alternative to
living in an intermediate care facility for individuals with an
intellectual disability or related conditions (ICF/IID). Recipients can
live in their own or family home, in a host home/ companion care
setting or in a residence with no more than three others who receive
similar services.
As appropriate to the recipient’s needs, services include:
l Residential assistance. l Transition assistance services.
l Dietary services. l Cognitive rehabilitation therapy.
l Day habilitation. l Licensed nursing services.
l Respite care. l Adaptive aids.
l Dental treatment. l Minor home modifications.
S upported home living.
l Pre-enrollment minor home modifications.
l Transportation.
l Employment assistance and supported employment.
l Professional therapies such as social work, behavioral support, occupational therapy, physical
therapy, audiology, cognitive rehabilitation, speech and language therapy.
l Financial Management Services and Support Consultation for the Consumer Directed
Services Option.
l
Service coordination is provided by the local intellectual and developmental disability authority.
The CDS option is available for those who live in their own or family home for supported home living
(transportation), respite, employment assistance, supported employment, cognitive rehabilitation
therapy, and nursing. Recipients using the CDS option must select a financial management services
agency (FMSA) to provide services such as payroll and employer taxes and can use support consultation
to help them manage the requirements of this service delivery option. Individuals transitioning from an
institutional stetting into HCS may also receive minor home modifications prior to enrollment.
With the availability of Community First Choice (CFC) effective June 1, 2015, the majority of
residential habilitation services are now available to all HCS waiver participants through the CFC state
plan services. However, transportation remains an exclusive HCS waiver service. State plan services,
including those provided under CFC, must be exhausted before using HCS waiver services.
Home and Community-based Services • Statistics
Average number of recipients served per month
36
FY 2014
FY 2015
20,703
22,443
$3545.96
$3525.30
Section II
l
Home and Community-based Services • Monthly Averages
by Local Intellectual and Developmental Disability Authority Service Area
Local Intellectual and Developmental Disability Authority
Anderson/Cherokee (ACCESS)
Andrews Center
Austin-Travis County Integral Care Center
Bluebonnet Trails Community MHMR Center
Border Region MHMR Community Center
Burke Center
Camino Real Community MHMR Center
Central Counties Center for MHMR Services
Coastal Plains Community MHMR Center
Denton County MHMR
El Paso MHMR Center (Emergence)
Gulf Bend MHMR Center
Gulf Coast Center
Heart of Texas Regional MHMR Center
Helen Farabee Regional MHMR Centers
Hill Country Community MHMR Center
LifePath Systems
Dallas Metrocare Services
MHMR Services of Texoma (Texoma Community Center)
Pecan Valley MHMR Region
Permian Basin Community Centers for MHMR
Spindletop MHMR Services
Starcare Specialty Health System
Texana Center
Texas Panhandle MHMR
Tri-County Services
West Texas Centers
State Total
Monthly Average • Recipients Served
FY 2014
FY 2015
48 304
733
315
1,762
639
159
318
121
180
292
40
105
427
487
633
135
637
333
214
514
727
436
1,633
332
2,881
493
1,403
341
113
309
198
381
454
921
368
297
843
147
67
331
793
313
1,878
694
187
344
147
186
313
46
110
472
488
665
129
665
372
258
560
765
467
1,770
338
3,083
505
1,685
337
109
328
235
424
521
989
417
329
994
140
20,703
22,443
Data Source: DADS Operating Budget FY 2016 • Claims Management System Payment Data • DADS Program Areas
37
DADS
l
Recipients may be any age and must:
l Meet the financial eligibility criteria as described in Appendix B of the HCS Program waiver
application approved by CMS and found at www.dads.state.tx.us.
l Qualify for an ICF/IID Level of Care (LOC) I or qualify for an ICF/IID LOC VIII and reside in a
nursing facility immediately prior to enrolling in HCS or be at imminent risk of entering a nursing
facility as determined by DADS.
l Have an Individual Plan of Care (IPC) that does not exceed:
– $167,468 for an applicant or individual with a level-of-need (LON) 1, LON 5, or LON 8.
– $168,615 for an applicant or individual with a LON 6.
– $305,877 for an applicant or individual with a LON 9.
* SSI levels are adjusted at the federal level each year based upon annual changes in the Consumer Price Index.
— Statutory Authority. Social Security Act § 1915(c) [42 U.S.C. § 1396n(c)];
Texas Human Resources Code chapter 32 and § 161.071(1) and (3).
— Rules. Title 40 TAC. Chapter 9, Subchapter D.
The CLASS program provides services and supports for people with related conditions as an alternative
to living in an ICF/IID. Recipients can live in their own or family home.
Services include:
A
daptive aids and medical
supplies.
l Case management.
l Cognitive rehabilitation therapy
l Minor home modifications.
l Nursing services.
l B ehavioral support services.
l Respite.
l Occupational therapy.
l
hysical therapy.
P
l Speech and language therapy.
l Prevocational services.
l Supported employment.
l Prescriptions.
l Support family services.
l Transition assistance services.
l Dental services.
l Dietary services.
l
mployment assistance.
E
Continued family services.
l Financial management services
and support consultation for
the CDS option.
l Specialized therapies (such
as recreation therapy, music
therapy, massage therapy,
aquatic therapy, and therapeutic
horseback riding).
l
l
With the availability of Community First Choice (CFC) effective
June 1, 2015, the majority of residential habilitation services are now
available to all CLASS waiver participants through the CFC state
plan services. However, transportation remains an exclusive CLASS
waiver service. State plan services, including those provided under
CFC, must be exhausted before using CLASS waiver services.
Case management services are delivered through a contracted
case management agency. Recipients may choose a licensed home
health agency to provide all services or they may use the consumer
directed services delivery option, which is available for habilitation,
respite, nursing, physical therapy, occupation therapy, supported
employment, and speech and language therapy. Recipients using
the CDS option must select a financial management services agency
38
Section II
l
(FMSA) to provide services such as payroll and employer taxes, and can use support consultation to
help them manage the requirements of this service delivery option.
Recipients may be any age, and must:
l Have a monthly income within 300 percent of the monthly income limit for SSI ($2,199/month*).
l Have countable resources of no more than $2,000.
l Have an Individual Plan of Care (IPC) that does not exceed $114,736.07
— Statutory Authority. Social Security Act § 1915(c) [42 U.S.C. § 1396n(c)]; Texas Human Resources Code chapter
32 and § 161.071(1) and (3).
Community Living Assistance and Support • Statistics FY 2014
FY 2015
4,649
4,868
$3,711.06
$3,816.58
Community Living Assistance and Support Services • Monthly Averages
by Region
Number Percent of
Region
Served
2 Abilene
3 Grand Prairie
192
4.10%
871.90%
1,084
23.30%
Number Percent of
Served
State Total
202
4.10
891.80%
1,130
23.20%
4 Tyler
1854.00%
1994.10%
5 Beaumont
1453.10%
1493.10%
6 Houston
817
877
7 Austin
61613.30%
64713.30%
8 San Antonio
658
674
9 Midland
17.60%
14.20%
861.80%
18
13.80%
841.70%
10 El Paso
240
5.20%
252
5.20%
11 Edinburg
539
11.6%%
565
11.60%
State Total
4,649100.00%
4,868100.00%
39
l
The DBMD Program provides services and supports as an alternative to living in an ICF/IID to people
with deaf-blindness and one or more other disabilities. Recipients may live in their own or family home
or in group homes of no more than six persons.
DADS
Services include:
l Adaptive aids and medical supplies.
l Dental services and dental sedation.
l Assisted living.
l B ehavioral support services.
l Case management.
l Chore services.
l Residential habilitation.
l Day habilitation.
l Intervener services.
l Nursing services.
l Occupational therapy.
hysical therapy.
P
l Orientation and mobility.
l Respite.
l Speech, language and audiology therapy.
l Supported employment.
l Employment assistance.
l Dietary services.
l Support consultation for the consumer directed
services (CDS) option.
l Financial management services for the consumer
directed services (CDS) option.
l
With the availability of Community First Choice (CFC) effective June 1, 2015, the majority of residential
habilitation services are now available to all DBMD waiver participants through the CFC state plan
services. However, transportation remains an exclusive DBMD waiver service. State plan services,
including those provided under CFC, must be exhausted before using DMBD waiver services.
The CDS option is avaiable for the following services: residential habilitation, respite, intervener
services, supported employment, employment assistance and Community First Choice Personal
Assistance Services/Habilitation (CFC PAS/HAB). Recipients using the CDS option must select a
financial management services agency (FMSA) to provide financial management services, such as
payroll and employer taxes, and can use support consultation to help them manage the requirements
of this service delivery option.
Recipients may be any age (but their condition must manifest before age 22)
and must:
l Have a condition that will result in deaf-blindness, or have deaf-blindness
with one or more other disabilities impairing independent functioning.
l Have a monthly income that is within 300 percent of the monthly income
limit for SSI ($2,163/month*).
l Have countable resources of no more than $2,000.
l Have an Individual Plan of Care (IPC) with a cost for DBMD Program
services at or below $114,736.
— Statutory Authority. Social Security Act § 1915(c) [42 U.S.C. § 1396n(c)]; Texas
Human Resources Code chapter 32 and § 161.071(1) and (3).
40
Section II
FY 2014
FY 2015
158
203
$4,181.33
$3,771.60
Average monthly cost per recipient Programs and Services
l
Deaf Blind with Multiple Disabilities • Statistics
Deaf Blind with Multiple Disabilities • Monthly Averages
by Region
FY2014• Monthly Average
Number Percent of
Region
Served
State Total FY2015• Monthly Average
Number Percent of
Served
State Total
1 Lubbock
74.70%
73.70%
2 Abilene
10.70%
31.70%
3 Grand Prairie
23
14.50%
36
17.80%
4 Tyler
85.30%
84.00%
5 Beaumont
21.60%
52.60%
6 Houston
4528.60%
5828.60%
7 Austin
2415.10%
2713.40%
8 San Antonio
27
34
17.30%
16.50%
9 Midland
42.70%
52.60%
10 El Paso
6
7
11 Edinburg
96.00%
State Total
3.50%
156100.0%
3.50%
125.70%
202100.0%
Data Source: DADS Operating Budget FY 2016 • Claims Management System Payment Data • DADS Program
The MDCP provides a variety of services to support families caring for children who are medically
dependent, and to encourage de-institutionalization of children who are receiving services in
nursing facilities.
Specific services include:
l Adaptive aids.
l Employment assistance.
l Flexible family support services.
l Respite.
S upported employment.
l Financial management services for the
consumer directed services (CDS) option.
l
41
DADS
l
The CDS option is available for respite, flexible family support
services, employment assistance, and supported employment.
Recipients using the consumer directed services delivery option
must select a financial management services agency (FMSA) to
provide financial management services, such as payroll taxes.
Recipients must:
l B e under 21.
l B e a Texas resident.
l B e a citizen of the United States or an alien with approved status.
l Meet the medical necessity requirements* for nursing
facility care.
eet financial eligibility based on Medicaid eligibility: Recipients of SSI or Medical Assistance Only
M
based on the income and resources of the child (a monthly income that is within 300 percent of the
monthly income limit for SSI [$2,199/month**] and countable resources of no more than $2,000),
or all other mandatory and optional TANF-related groups in the Texas Medicaid State Plan.
l Have an Individual Plan of Care (IPC) not exceeding 50 percent of the reimbursement rate
that would have been paid for the same services in a nursing facility.
l
*See the appendices for a description of the medical necessity determination process.
** SSI levels are adjusted at the federal level each year based upon annual changes in the Consumer Price Index.
— Statutory Authority. Social Security Act § 1915(c) [42 U.S.C. § 1396n(c)]; Texas Human Resources Code
chapter 32 and § 161.071(1) and (3).
Medically Dependent Children Program • Monthly Averages
by
Region
Number Percent of
Region
Served
1145.00%
944.30%
2 Abilene
442.00%
391.80%
3 Grand Prairie
690
4 Tyler
1416.20%
1255.70%
743.30%
753.40%
5 Beaumont
30.30%
644
29.30%
6 Houston
49321.70%
52123.70%
7 Austin
2109.20%
2049.30%
8 San Antonio
283
271
12.40%
12.30%
9 Midland
492.10%
411.90%
10 El Paso
51
54
11 Edinburg
State Total
2.20%
1285.60%
2,279100.00%
42
Number Percent of
Served
State Total
2.50%
1305.90%
2,198100.00%
Average monthly cost per recipient FY 2014
FY 2015
2,279
2,198
$1,430.48 $1,411.05
l
Section II
Medically Dependent Children Program • Statistics
Texas Home Living (TxHmL)
The TxHmL Program provides essential services and supports for people with intellectual or
developmental disabilities as an alternative to living in an ICF/IID. Recipients must live in their own
or family homes.
Services include:
ommunity support (transportation).
C
l Day habilitation.
l Respite services.
l Employment assistance and supported
employment.
l Licensed nursing.
l Adaptive aids. l Minor home modifications.
l
ental treatment.
D
l Professional therapies such as occupational
therapy, physical therapy, audiology, speech/
language pathology, dietary services and
behavioral support services.
l Financial management services and support
consultation for the consumer directed services
(CDS) option.
l
With the availability of Community First Choice (CFC) effective June 1, 2015, the majority of residential
habilitation services are now available to all TxHmL waiver participants through the CFC state plan
services. However, transportation remains an exclusive TxHmL waiver service. State plan services,
including those provided under CFC, must be exhausted before using TxHmL waiver services.
Services are coordinated by the local intellectual and developmental disability authority service
coordinator. The CDS option is available for all services. Recipients must select a financial management
services agency (FMSA) to provide financial management services, such as payroll and employer taxes,
and may use support consultation to assist them in managing the requirements of this service
delivery option.
A recipient may be of any age, and must:
l Meet the financial eligibility criteria as described in Appendix B of the TxHmL Program waiver
application approved by CMS and found at www.dads.state.tx.us.
l Qualify for an ICF/IID Level of Care (LOC) I.
l Live in their own home or family’s home.
l Not be assigned a Pervasive Plus Level of Need (LON) 9.
l Have an Individual Plan of Care (IPC) that does not exceed $17,000.
— Statutory Authority. Social Security Act § 1915(c) [42 U.S.C. § 1396n(c)]; Texas Human Resources Code
Chapter 32 and § 161.071(1) and (3).
— Rules. Title 40 TAC. Part 1. Chapter 9, Subchapter N.
43
Texas Home Living • Monthly Averages
by Local Intellectual and Developmental Disability
Authority Service Area
l
DADS
Anderson/Cherokee (ACCESS)
Andrews Center
Austin-Travis County Integral Care Center
Bluebonnet Trails Community MHMR Center
Border Region MHMR Community Center
Burke Center
Camino Real Community MHMR Center
Coastal Plains Community MHMR Center
Denton County MHMR
El Paso MHMR Center (Emergence)
Gulf Bend MHMR Center
Gulf Coast Center
Helen Farabee Regional MHMR Centers
Hill Country Community MHMR Center
LifePath Systems
Dallas Metrocare Services
MHMR Services of Texoma (Texoma Community Center)
Pecan Valley MHMR Region
Permian Basin Community Centers for MHMR
Spindletop MHMR Services
Texana Center
Tri-County Services
West Texas Centers
State Total
Data Source: DADS Operating Budget FY 2016 • Claims Management System Payment Data • DADS Program Areas
44
Monthly Average • Recipients Served
FY 2014
FY 2015
47 85
138
81
352
189
87
80
110
37
102
57
72
65
89
101
45
102
176
58
82
177
80
574
67
579
114
419
46
28
41
66
174
76
184
121
75
242
77
32
79
135
69
378
160
79
80
124
39
120
58
66
58
125
102
64
110
168
43
104
209
127
596
69
703
96
444
46
41
47
42
151
75
235
101
97
291
74
5,297
5,641
Average monthly cost per recipient FY 2015
5,297
5,641
$824.90 $898.06
FY 2014
l
Section II
Texas Home Living • Waiver Statistics Data Source: DADS Operating Budget FY 2016
45
Community Services and Supports – Non-Medicaid
DADS
l
Non-Medicaid services and supports are provided in community settings to help people who are
aging and those with disabilities remain in the community, maintain their independence and
avoid institutionalization.
Community Services and Supports – Non-Medicaid
l
l
IDD Community Services
l
Promoting Independence through Outreach, Awareness and Relocation
l
In-Home and Family Support Program (IHFSP)
Title XX – Social Services
Adult Foster Care (AFC) • Provides a 24-hour living arrangement with supervision in an adult foster
home for people who, because of physical, mental or emotional limitations, are unable to continue
independent functioning in their own homes. AFC providers must live in the household and share a
common living area with the recipient. Providers may serve no more than three adults in a DADSenrolled AFC home unless it is licensed by DADS as a Type C Assisted Living Facility or as a Type
A Small Group Home. Services may include help with activities of daily living and provision of or
arrangement for transportation. Those receiving services pay the provider for room and board.
Consumer Managed Personal Attendant Services • Provides personal attendant services to people with
physical disabilities who are willing and able to supervise their attendant or who have someone who
can do so. Recipients interview, select, train, supervise and release their attendants. The CDS option is
available for this service, which is available in various counties in eight regions.
Day Activity and Health Services • Licensed facilities provide daytime services Monday through Friday to
people living in the community. Services are designed to address individuals’ physical, mental, medical
and social needs.
Emergency Response Services • Provides a 24-hour electronic monitoring system for functionally
impaired adults who live alone or are socially isolated in the community. In an emergency, the recipient
can press a call button to signal for help.
Family Care • Attendant care service available to eligible adults who are functionally limited in
performing activities of daily living. Services include assistance with personal care activities, home
management tasks, meal preparation and escort services. The CDS option is available for Family Care,
and in some areas of the state, the Service Responsibility Option is also available.
Home-Delivered Meals • Provides a nutritious meal delivered by community-based provider agencies to
the recipient’s home.
46
Section II
l
Residential Care • Provides services for eligible adults
who require 24-hour access to care but who do not
require daily nursing intervention. Care is provided in
DADS-licensed assisted living facilities. The recipient
pays the provider for room and board and may also
have co-payment liability. Services are provided through
residential care or emergency care. Emergency care is a
temporary arrangement.
Special Services to Persons with Disabilities • Services
provided in a variety of settings. Services are not available
statewide. These services help recipients develop the skills
needed to remain in the community as independently
as possible.
Recipients must:
l
l
Be at least 18 years old.
e Medicaid eligible or have a monthly income of no more than three times the standard SSI payment
B
level ($2,199).
l
Have resources of no more than $5,000.
l
Meet the functional assessment score requirements of the specific service.
— Statutory Authority. Social Security Act Title XX [42 U.S.C. §§ 1397-1397f]; Texas Human Resources Code
§ 161.071(1) and (3)
— Rules. 45 C.F.R. part 96; Title 40 TAC. Part 1. Chapters 44, 46, 48, 52, 55, and 58.
47
Non-Medicaid Services (Title XX) • Statistics
At End of FY 2015
DADS
l
AgeSex
Ethnicity
African
American
WhiteUnknown
Service
0–17 18–64 +65 Female Male Unknown Hispanic (not Hispanic) (not Hispanic) or Other
Adult Foster Care
0
0
16
Client Managed
Personal Attendant
Services
0
0 388 228158
2
Day Activity
and Health Services
0
2
2
2,602
Emergency
Response
1
0 15,26112,2093,043
9
Family Care
2
1
4
Home Delivered
Meals
1
3 15,147 9,7675,369
Residential Care
0
1
380
138
Special Services
to Persons
with Disabilities
0
0
73
34
3,183
5,761
6
10
0
2
11
44
251
268
40
3,078
4,550
6,330
1,893
1,010
2,541
14
3,659
4,266
5,732
243
0
41
76
230
23
39
0
8
29
29
4
3,897 1,861
65
0
151
1,824 1,359
122
2
1,134
272
1,370
D ata Source: Claims Management System payment data
Non-Medicaid Services (Title XX) • Monthly Averages
by
Service
FY 2014
Number Service
Served
Adult Foster Care
Client Managed Personal Attendant Services
Day Activity and Health Services
Emergency Response Services
Family Care
Home Delivered Meals
Residential Care
Special Services to Persons with Disabilities
Total (Unduplicated) Non-Medicaid Services Data Source: Claims Management System payment data
48
FY2015
Cost per
Person Number Served
Cost per
Person
25
$436.99 16
$431.34
394
$1,130.81 388
$1,196.02
2,858
$511.34 2,836
$536.07
12,740
$23.27 12,396
$23.52
5,457
$595.34 5,391
$628.78
14,359
$102.39 14,173
$102.38
404
$735.69 372
$737.79
80
$1,011.76 72
$1,001.74
36,317
$218.08 35,644
$236.80
Section II
l
Non-Medicaid Community Services
and Supports (Title XX) • Monthly Averages
by Region
FY2014FY2015
Number Percent of
Number Percent of
Region
Served
State Total Served
State Total
1 Lubbock
1,5434.7% 1,5444.0%
2 Abilene
3,48210.6%
4,38611.4%
3 Grande Prairie
4,935
6,174
4 Tyler
4,53613.8%
5 Beaumont
2,1016.4% 2,7287.1%
6 Houston
1,7155.2% 1,8504.8%
7 Austin
2,3547.1% 3,3708.7%
8 San Antonio
4,037
9 Midland
1,5944.8% 1,7194.5%
10 El Paso
2,610
11 Edinburg
4,07812.4%
State Total
15.0%
12.2%
7.9%
16.0%
5,51514.3%
4,193
2,507
10.9%
6.5%
4,54411.8%
32,985100% 38,531100%
Data Source: Claims Management System payment data
Nutrition Services
DADS Access and Intake contracts with the 28 area agencies on aging (AAA) to support a statewide
system of nutrition services funded through the Older Americans Act (OAA).
These services include:
l
Congregate meals.
l
Home-delivered meals.
l
Nutrition education.
l
Nutrition counseling.
l
Nutrition consultation.
Because adequate nutrition is vital to maintaining the health and independence of older people,
nutrition services are the most-used services authorized under the OAA. AAA congregate and homedelivered meal services represent the “social model” of preventive services promoted by the OAA. They
reflect the vital role of diet in the health and independence of people who are older by promoting health
and well-being.
Services are provided through subcontractors or vendors, who must comply with the most recent
Dietary Guidelines for Americans published by the Secretary of Agriculture. These meal providers serve
each recipient a meal based on a minimum of 33 1/3 percent of the dietary reference intakes established
49
DADS
l
by the Food and Nutrition Board of the Institute of Medicine of the
National Academy of Science. Approximately 384 providers across
the state deliver these services through the AAA network. The
objective of the nutrition services program is to help participants
sustain healthy, independent lives.
Congregate Meals • A hot or other appropriate meal served to an
eligible person in congregate settings, which include nutrition sites,
multipurpose senior centers, day activities and health services
facilities and multi-generational meal sites. Both standard meals and
therapeutic meals/liquid supplements may be provided.
Home-delivered meals • A meal including hot, cold, frozen, dried,
canned, fresh or a supplemental food (with a satisfactory storage
life) provided to older people who are assessed as frail and homebound. Meals are delivered to eligible
recipients in their homes. The objective is to reduce food insecurity and help recipients sustain
independent living in a safe and healthful environment. There are two types of home-delivered meals:
standard meals and therapeutic meals/liquid supplements.
Nutrition Education • Information provided to older people to promote nutritional well-being
and to delay the onset of adverse health conditions resulting from poor nutritional health or
sedentary behavior.
Nutrition Counseling • Individualized advice about options to improve nutritional status for those at
risk because of their health or nutritional history, dietary intake, medication use or chronic illness.
Counseling is performed by a health professional in accordance with state law and policy.
Nutrition Consultation • The provision of information related to nutrition by a licensed dietitian or other
qualified person. Services are to be provided to AAAs or nutrition providers.
l
l
l
l
S ervices are provided to people 60 and older and are targeted to those with greatest economic and
social need, and those at risk for institutional placement, with particular attention to low-income
minority aging people with limited English proficiency and those who live in rural areas.
In congregate settings, the spouse of someone 60 years of age or older is eligible for a meal
at the meal site.
I f the nutrition service provided is a home-delivered meal, the older person must be homebound
and have difficulty performing activities of daily living. Family members or other caregivers may
also receive nutrition services through a home-delivered meal as a method of providing respite.
Additionally, in accordance with the OAA, a meal may be provided to those with disabilities who live
at home with an eligible older person.
I n cases where a congregate nutrition site is in a housing facility occupied primarily by older people,
a person with disabilities under the age of 60 may attend the site and receive a congregate meal.
— Statutory Authority. Older Americans Act of 1965 [42 U.S.C. chapter 35]; Texas Human Resources Code
§§ 101.025, 101.030, and 161.071(5).
— Rules. 45 C.F.R. part 1321; Title 40 TAC. Part 1. Chapter 85, Subchapter D §§ 85.302, and 85.306(e)(3).
50
l
FY 2014
FY 2015
50,965
52,524
3,124,938
3,134,427
Statewide average cost per congregate meal $5.54 $5.47
Number of home-delivered meal recipients 36,801
37,132
4,385,963
4,319,346
$5.04 $5.08
Number of congregate meals recipients Number of congregate meals served
Number of home-delivered meals served
Statewide average cost per home-delivered meal
Section II
Statewide Nutrition Services • Statistics Number of Meals Provided by Area Agencies on Aging • FY 2015
Congregate Meals
Home-delivered Meals
Area Agency on Aging of the Alamo Area
98,682
149,101
Area Agency on Aging of Ark-Tex Area
63,277
71,632
Area Agency on Aging of Bexar County
423,254
254,865
Area Agency on Aging of Brazos Valley
Area Agency on Aging of the Capital Area
31,428
44,910
133,659
278,106
Area Agency on Aging of Central Texas
39,014
49,177
Area Agency on Aging of the Coastal Bend
83,085
122,380
Area Agency on Aging of Concho Valley
23,119
30,539
Area Agency on Aging of Dallas County
337,820
108,121
Area Agency on Aging of Deep East Texas
96,692
89,933
Area Agency on Aging of East Texas
68,154
244,311
Area Agency on Aging of the Golden Crescent Region
Area Agency on Aging of Harris County
Area Agency on Aging of the Heart of Texas
32,090
96,220
237,755
704,754
57,076
114,072
Area Agency on Aging of Houston ñ Galveston
203,981
278,667
Area Agency on Aging of the Lower Rio Grande Valley
150,637
236,452
Area Agency on Aging of the Middle Rio Grande Area
49,851
44,686
167,315
544,199
Area Agency on Aging of North Texas
18,544
49,738
Area Agency on Aging of the Panhandle Area
42,626
50,299
Area Agency on Aging of the Permian Basin
47,202
88,810
Area Agency on Aging of the Rio Grande Area
Area Agency on Aging of North Central Texas
164,906
77,133
Area Agency on Aging of Southeast Texas
61,351
43,338
Area Agency on Aging of South Plains
97,415
43,563
Area Agency on Aging of South Texas
83,206
70,172
203,078
298,203
Area Agency on Aging of Texoma
23,541
46,594
Area Agency on Aging of West Central Texas
95,669
89,371
3,134,427
4,319,346
Area Agency on Aging of Tarrant County
Total
51
Services to Assist Independent Living
DADS
l
The OAA authorizes a wide range of support
services that allow older people to lead independent,
meaningful and dignified lives in their own homes
and communities as long as possible. Services
are provided through subcontractors, or may be
authorized by the AAAs through coordination of care
or caregiver support.
DADS Access and Intake, and the 28 AAAs with
which it contracts, support a comprehensive,
coordinated community-based statewide system of
supportive and in-home services under the OAA that
results in a continuum of services for older people and their caregivers. The OAA emphasizes prevention
and wellness through its wide variety of evidence-based disease prevention programs offered by AAAs
directly and through partnerships. It is the intent of the OAA that allocated funds be used as a catalyst
in bringing together public/private and formal/informal resources in the community to assure the
provision of a full range of efficient, well-coordinated and accessible services for older people.
In-home and other support services include:
Adult Day Services • Services provided in a congregate, non-residential setting to dependent older
people who need supervision but do not require institutionalization. These services may include any
combination of social or recreational activities, health maintenance, transportation, meals and other
supportive services.
Caregiver Respite Care – In-home • Temporary relief for caregivers, including an array of services provided
to dependent older people who need supervision. Services are provided in the recipient’s home on a
short-term, temporary basis while the primary caregiver is unavailable or needs relief. In addition to
supervision, services may include meal preparation, housekeeping, assistance with personal care, or
social and recreational activities.
Caregiver Respite Care – Institutional • Temporary relief for caregivers, including services provided in a
congregate or residential setting (e.g., hospital, nursing home, adult day care center) to dependent older
people who need supervision. Services are offered on a short-term, temporary basis while the primary
caregiver is unavailable or needs relief. Services may include meals, social and recreational activities,
personal care, monitoring of health status, medical procedures or transportation.
Caregiver Respite Care – Non-residential • Temporary relief for caregivers by providing supervised care
at senior centers or other non-residential program locations that are not licensed as adult-day care
facilities. Activities may include lunch and supervised recreational or social activities for dependent
older people who require supervision. Services are intermittent or temporary while the primary
caregiver is unavailable or needs relief.
Chore Maintenance • Performance of household chores such as heavy cleaning (e.g., scrubbing floors,
washing walls and outside windows), moving heavy furniture, yard and walk maintenance, which
an older person is unable to handle on their own and which do not require the services of a
trained homemaker.
52
Section II
l
Emergency Response Services (ERS) • Services provided to homebound and frail older people to establish
an automatic monitoring system, which links to emergency medical services when personal safety is in
jeopardy. ERS services include the installation of the individual monitoring unit, training in the use of
the system, periodic checking to ensure that the unit is functioning properly, equipment maintenance
calls, response to emergency calls by a medical professional, paraprofessional or volunteer, and followup with the older person.
Evidence-based Disease Prevention • Activities and programs that provide intervention to older people
based on evidence-based programming, which is the application of principles of scientific reasoning,
behavior change theory and program planning proven effective in reducing the risk of disease, disability
and injury among older people to maintain or improve health.
Health Maintenance • The provision of medications, nutritional supplements, glasses dentures, hearing
aids or durable medical equipment to prevent or reduce the effects of chronic disabling conditions.
Services may also include health education and counseling services, as well as home health services
including, nursing, physical, speech or occupation therapy.
Health Screening/Monitoring • Activities assess the health and wellness of older people. Services may be
provided at senior centers, nutrition sites and other community settings or in the recipient’s home. These
services may include blood-pressure monitoring, hearing and vision impairments, nutritional status,
home safety, etc.
Homemaker • Trained and supervised homemakers perform housekeeping/home management,
meal preparation, escort tasks or shopping assistance for older people who require help with these
activities in their home. The objective is to help older people live independently in a safe and healthful
home environment.
Instruction and Training • These services provide opportunities for people or professionals working with
the older person to acquire skills in a formal, informal, individual or group setting.
Personal Assistance • Helping an older person who is having difficulty performing a minimum of two
activities of daily living identified in the assessment process with tasks the person would typically
perform if they were able. This covers hands-on assistance in all activities of daily living.
Residential Repair • Services consist of repairs or modifications of dwellings occupied by older people
that are essential to the health and safety of the occupants.
Senior Center Operations • The operation of community facilities where older people gather to pursue
mutual interests, receive services or take part in activities that will enhance their quality of life, support
their independence, and encourage their continued involvement in and with the community.
Transportation – Assisted • Assistance and transportation, including escort, provided to older people
with physical or cognitive disabilities that make it difficult to use regular transportation. The service
includes helping them prepare for the trip; assisting them from their home into the vehicle; providing
the transportation; assisting them from the vehicle to the destination, such as the doctor’s office; staying
with them at the destination; and assisting them similarily with a return trip.
Transportation Demand/Response • Transportation services that carry older people from a specific origin
to a specific destination upon request. Recipients request transportation services 24 to 48 hours before
the trip.
53
Transportation Fixed Route • Transportation service that operates on a predetermined route with
permanent transit stops and clearly marked route numbers and departure schedules. The fixed route
does not vary and the provider strives to reach each transit stop at the scheduled time.
DADS
l
Caregiver Respite Care-Voucher • A service provided through the consumer directed services option in
which the caregiver chooses an individual provider. Services are intermittent or temporary while the
primary caregiver is unavailable or needs relief. Respite vouchers may be used for in-home, institutional
and non-residential respite services. The care recipient must be unable to perform two or more activities
of daily living or, due to cognitive impairment, require substantial supervision.
Homemaker-Voucher • A service provided through the consumer directed services option in which the
program participant chooses an individual provider. Services may include performing housekeeping/
home management, meal preparation, escort tasks and shopping assistance. Services are provided
to older people who require assistance with these activities in their home. The objective is to help
participants sustain independent living in a safe and healthful home environment.
Eligibility Requirements • Services are provided for people 60 and older and are targeted to those with
greatest economic and social need. Emphasis is on providing services to older members of low-income
minority groups, those with limited English proficiency and those living in rural areas. Additionally,
family members or other caregivers may receive information and services on behalf of the older person
for whom they are providing care. Services may also be provided to family caregivers caring for people
of any age when diagnosed with Alzheimer’s disease or related dementia.
— Statutory Authority. Older Americans Act of 1965 [42 U.S.C. chapter 35]; Texas Human Resources Code chapter
101, Subchapter C, and §§ 101.025, 101.030 and 161.071(5).
— Rules. 45 C.F.R. part 1321; Title 40 TAC. Part 1. Chapter 83, Rule § 83.3(k)(2) and (o)(1)(C).
Services to Assist Independent Living • Statistics
Number of homemaker services recipients
Average cost per homemaker services recipient
Number of personal assistance recipients
Average cost per personal assistance recipient
Number of homes repaired or modified
Average cost per repaired/modified home
Number of one-way trips
Number of Retired and Senior Volunteer Program volunteers (RSVP)
54
FY 2014
FY 2015
1,347
1,335
$ 540.82
$584.92
793
792
$990.20
$ 1,079.87
1,700
1,700
$ 1,445.53
$ 1,131.00
685,950
688,393
31,500
31,500
Section II
Homemaker Services
Recipients
Personal Assistance
Recipients
71
27
61
3,936
Area Agency on Aging of Ark-Tex
87
12
22
37,838
97
42
119
97,056
31
0
1
14,840
166
17
26
22,928
40
25
0
2,743
0
51
98
9,495
34
0
0
8,440
2
3
232
96,142
30
0
43
1,758
121
80
12
27,147
13
4
10
6,963
8
105
7
39,879
20
53
108
0
0
150
54
60,343
103
0
96
39,385
Area Agency on Aging of the Middle Rio Grande Area
24
20
36
6,822
92
0
159
67,704
0
0
29
4,501
Area Agency on Aging of the Panhandle Area
50
3
46
14,769
0
2
20
6,048
138
168
18
22,717
7
9
15
10,479
18
0
47
10,268
79
31
146
33,759
0
0
274
40,159
0
0
14
70
104
2
7
5,204
Area Agency on Aging of Houston – Galveston
Total
1,335
Homes Repaired
or Modified
792
l
Services Provided by Area Agencies on Aging • FY 2015
Transportation
One-Way Trips
1,700688,778
55
Intellectual and Developmental Disability
Community Services
DADS
l
Intellectual and Developmental Disability (IDD) Community
Services include services and supports provided to those in
the DADS intellectual and developmental disability priority
population who live in the community. These services do not
include those provided through an ICF/IID or Medicaid waiver
program. These services help people participate in age-appropriate
community activities and services.
Services include:
Community Supports – Individualized activities provided in the
recipient’s home or at community locations to help them perform
functional living skills and other daily living activities.
Day Habilitation Services – Services provided in a group setting
away from the recipient’s home to help them develop and refine
skills necessary to live and work in the community.
Eligibility Determination – Assessment or endorsement conducted by the local intellectual and
developmental authority to determine if a person has an intellectual disability or related condition and is
a member of the DADS intellectual and developmental disability priority population.
Employment Services – Support services to help people secure and maintain community employment.
Respite – Services that can be provided in or outside of the recipient’s home to temporarily relieve family
members or other unpaid primary caregiver of their responsibilities.
Behavioral Support – Specialized interventions by professionals with required credentials to help recipient
increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere
with the recipient’s inclusion in home and family life or community life.
Therapies – Support services provided by licensed or certified professionals, including psychology,
nursing, social work, occupational therapy, speech therapy, physical therapy, dietary services and certain
behavioral health services.
The DADS intellectual and developmental disability priority population consists of people who meet
one or more of the following descriptions:
l
l
l
56
People with an intellectual disability as defined by Health and Safety Code, §591.003.
People with autism spectrum disorder as defined in the Diagnostic and Statistical Manual for
Mental Disorders.
People with a related condition who are enrolling in the ICF/IID program, Home and
Community-based Services (HCS) program, or the Texas Home Living (TxHmL) program.
ursing facility residents who are eligible for specialized services for an intellectual and developmental
N
disability pursuant to Section 1919(e)(7) of the Social Security Act.
l
l
Section II
l
Children who are eligible for Early Childhood Intervention services through the Texas Department
of Assistive and Rehabilitative Services (DARS).
— Statutory Authority. Texas Health and Safety Code §§ 533.035 and 533.0355 and chapter 534.
— Rules. Title 40 TAC. Part 1. Chapter 2; and chapter 4, Subchapters C, K, and L.
Community Services • Monthly Averages FY 2014
FY 2015
Number receiving assessment and service coordination
29,691
32,782
Cost per person for assessment and service coordination
$169.00
$162.00
Number eligible for community services and supports
106,361
89,818
$40.40
$48.45
FY 2014
FY 2015
5,821
5,761
$507.48
$477.26
Cost per case for community services and supports
Community Services • Monthly Averages Average number of recipients served per month*
Average monthly cost per recipient
* Data for this measure are not comparable to publications prior to 2007 due to a change in the calculation methodology.
57
Community Services • Average Served per Month
l
DADS
Monthly Average Receiving Non-Medicaid Community Services
FY 2015
ACCESS62
300
Andrews101
239
115
186
Border Region Behavior Health Center
57
Burke Center
62
54
52
105
75
67
98
134
106
Gulf Bend Center
27
Gulf Coast Center
121
131
97
Hill Country Community Mental Health and Developmental Disabilities Centers
125
151
LifePath Systems
125
Metrocare Services
740
59
748
MHMR of Nueces County
64
MHMR Tarrant County
510
MHMR Services for Concho Valley
57
65
67
Spindletop Center
189
StarCare69
Texana Center
195
168
49
Tri-County Services
150
121
West Texas Centers
69
Total
58
5,911
Section II
l
Outreach, Awareness and Relocation
The Texas Promoting Independence Plan was developed in response to the U.S. Supreme Court ruling
in Olmstead v. L.C. and two executive orders, GWB 99-2 and RP13. Two activities under the larger
Promoting Independence Plan include community outreach and awareness and relocation services.
Community outreach and awareness is a public information campaign targeting groups involved in
decisions regarding long-term services and supports.
Relocation services involve assessment and case management to assist nursing facilities residents who
choose to relocate to community-based services and supports. It includes funding for Transition to
Living in the Community (TLC) services to cover establishing and moving to a community residence.
Residents of nursing facilities who relocate to the most integrated community setting of their choice
require a thorough assessment, intensive case management, housing assistance and funds to set up a
community residence. Intensive case management may be needed to implement the service and support
systems so they can return to the community. With limited income and resources, Medicaid recipients
in facilities may require help, such as security deposits, to set up community households, and assistance
to purchase household goods and groceries.
Relocation assistance and relocation funding, in combination or separately, allow more people to return
to the community.
l
Living in a nursing facility and requesting community placement.
Promoting Independence – Relocation Services • Statistics
FY 2015
Total number of contacts made with nursing facility residents 6,405
Total number of assessments completed to evaluate for potential relocation 2,264
Total number of relocations to the community with the assistance of relocation services 1,106
Promoting Independence – Relocation Services • Estimated Expenditures
Annual Cost for Relocation Contractor Assistance
Annual Cost for Transition to Life in the Community (TLC) Services
FY 2014
$3,661,537
$496,554.47
59
In-Home and Family Support Program (IHFSP)
DADS
l
The IHFSP provides direct grant benefits to eligible people with
physical disabilities (without a primary diagnosis of intellectual
disability) as a means to purchase the support they need to
remain in the community.
Services include:
l
l
l
l
Attendant care, home health services, home health aide services,
homemaker services and chore services.
Medical, surgical, therapeutic, diagnostic and
other health services.
re-approved transportation and room and board cost incurred
P
by the person with a physical disability or his family during
evaluation or treatment.
urchase or lease of special equipment or architectural
P
modifications of a home to facilitate the care, treatment therapy
or general living conditions of a person with a disability.
l
Respite care.
l
Counseling and training programs that help provide proper care of a person with a disability.
The IHFSP provides up to $1,200 per certification year in funds for eligible people.
The recipient of IHFSP services has unique needs based on functional limitations resulting from a
physical disability. Recipients are empowered to make decisions about their own service needs and to
make choices based on those needs, which enable them to live independently in their communities.
The IHFSP empowers them by upholding the value of the family and helping the family serve as the
primary support. IHFSP service recipients can exercise their options and are encouraged
to take personal responsibility for their choices. IHFSP services may supplement, but not supplant,
services received through other funding sources.
Recipients must:
l
Be age 4 or older.
l
Have a physical disability that substantially limits one or more major life activities.
l
eet income eligibility criteria based on the State Median Income (SMI). Co-payments begin when an
M
applicant’s income is at or above 105 percent of the SMI.
There are no resource eligibility requirements.
— Statutory Authority. Texas Human Resources Code chapter 35 and § 161.071(1) and (3).
— Rules. Title 40 TAC. Part 1. Chapter 48, Subchapter F.
60
Section II
l
FY 2014
FY 2015
5,821 5,761
$68.93 $66.91
In-Home and Family Support Program • Statistics
Data Source: DADS Operating Budget FY2016, Claims Management System payment data
In-Home and Family Support Program • Monthly Averages
by Region
Number Percent of
Region
Served
Number Percent of
Served
State Total
1 Lubbock
145
2.40%
146
2.53%
2 Abilene
387
6.41%
395
6.85%
3 Grand Prairie
773
12.82%
705
12.24%
4 Tyler
1,15919.22%
1,13619.71%
5 Beaumont
252
4.18%
271
4.71%
6 Houston
908
15.05%
867
15.05%
7 Austin
278
4.61%
271
4.71%
8 San Antonio
461
7.64%
461
8.00%
9 Midland
213
3.53%
186
3.22%
10 El Paso
277
4.60%
297
5.16%
11 Edinburg
1,17819.54%
1,02717.82%
State Total
6,031
5,761
100%
100.00%
Data Sources: DADS Legislative Appropriation Request 2016/2017
61
Program of All-inclusive Care for the Elderly (PACE)
DADS
l
DADS promotes the development of integrated managed
care systems for people who are older and those with
disabilities by supporting the Program of All-inclusive Care
for the Elderly (PACE).
PACE provides community-based services in Amarillo/Canyon,
El Paso and Lubbock for people age 55 or older who qualify for
nursing facility admission.
PACE uses a comprehensive care approach, providing an array
of services for a capitated monthly fee. PACE provides all
health-related services, including in-patient and out-patient
medical care, and specialty services such as dentistry, podiatry, social services, in-home care, meals,
transportation, day activities and housing assistance.
A recipient must:
l B e 55 or older.
l Meet the medical necessity for nursing facility admission (see appendices for a description of the
medical necessity determination process).
l Live in a PACE service area (Amarillo/Canyon, El Paso or Lubbock).
l B e determined by the PACE Interdisciplinary Team as able to reside safely in the community.
l Have a monthly income within 300 percent of the Supplemental Security Income (SSI) monthly
income limit ($2,199 for an individual and $4,398 for a couple*).
l Have countable resources of no more than $2,000 for an individual and $3,000 for a couple.
— Statutory Authority. Social Security Act § 1934 [42 U.S.C. § 1396u-4]; Texas Human Resources Code §§ 32.053
and 161.071(1) and (3).
— Rules. 42 CFR. Part 460; Title 40 TAC. Chapter 60.
Program of All-Inclusive Care for the Elderly • Statistics
FY 2014
El Paso
Amarillo
Lubbock
Total
El Paso
Amarillo
Lubbock
Total
Data Sources: Claims Management System Payment Data • DADS Program Areas • DADS Operating Budget FY 2016
62
FY 2015
846
861
139136
88113
1,0731,110
$2,939.56 $2,342.92 $2,723.82 $2,908.06
$2,345.29
$2,691.30
$2,844.63 $2,816.89
Section II
l
Nursing Facility and Hospice Payments
Nursing facility and hospice payments are provided to promote quality
of care for people whose medical problems require nursing facility or
hospice care.
Nursing Facility Care – Provides institutional nursing care for people
whose medical condition regularly requires the skills of a licensed
nurse. The nursing facility must provide for the medical, nursing
and psychosocial needs of each recipient, including room and board,
social services, over-the-counter drugs (prescription drugs are covered
through the Medicaid Vendor Drug program or Medicare Part D),
medical supplies and equipment, personal needs items and rehabilitative
therapies. Daily Medicare skilled nursing facility co-insurance payments are also paid for those who
are eligible for both Medicare and Medicaid.
Starting March 1, 2015, people covered by Medicaid who are eligible for STAR+PLUS and live
in a nursing facility began receiving basic health services (acute care) and long-term care s
ervices through STAR+PLUS. People who get both Medicaid and Medicare (dual eligible) now
get their basic health services through Medicare and their long-term care services through
STAR+PLUS Medicaid.
Medicaid requires health plans to pay nursing facilities within 10 days of submission of a clean
claim and provide discharge planning, transitional care and other education programs about all
long-term care settings.
Medicaid Swing Bed – Permits participating rural hospitals to use their beds interchangeably to
provide acute hospital and long-term nursing facility care for people who are eligible for Medicaid
when Medicaid beds are not available in skilled nursing facilities in the same area.
Services Available to Eligible Residents of a Medicaid Nursing Facility
Augmentative Communication Device Systems – Provides reimbursement to the nursing facility for
a communication device (also referred to as a speech-generating device system) so the resident
can communicate. The request must be documented to be medically necessary by the resident’s
physician and receive authorization from DADS for reimbursement.
Customized Power Wheelchairs – Provides reimbursement to the nursing facility for a customized
power wheelchair that is designed, adapted and fabricated to meet the resident’s physical and
medical needs; the resident must be able to operate the wheelchair. A customized power wheelchair
must be documented by the resident’s physician to be medically necessary and for the exclusive use
of the resident for which it is designed. The nursing facility must receive authorization through
Texas Medicaid and Healthcare Partnership (TMHP) to ensure reimbursement before purchasing
a customized power wheelchair.
63
Emergency Dental Services – Provides reimbursement for emergency dental services for nursing facility
residents who are eligible for Medicaid.
Rehabilitative Services – Provides reimbursement for physical, occupational and speech therapy when
DADS
l
ordered by the resident’s physician for an initial evaluation. The physician may request approval for
additional evaluations and services with documentation of a new illness, an acute onset of illness, an
injury or a substantive change in a pre-existing condition.
To be eligible for Medicaid coverage in a nursing facility, a resident must:
l
l
l
Live in a Medicaid-certified facility for 30 consecutive days.
e eligible for Supplemental Security Income (SSI) from the Social Security Administration
B
or be determined by the Texas Health and Human Services Commission to be financially
eligible for Medicaid.
Meet medical necessity requirements.*
* See the appendices for a description of the medical necessity determination process.
Specialized Services for Individuals
with an Intellectual or Developmental Disability
The implementation of an individualized plan of care — developed under and supervised by the
interdisciplinary team consisting of a physician and other qualified intellectual disabilities professionals
— includes services directed toward:
l
l
e acquisition of the behaviors necessary for the resident to function with as much self-determination
Th
and independence as possible.
The prevention or deceleration of regression or loss of current optimal functional status.
Specialized services do not include services to maintain generally independent residents who can
function with little supervision or in the absence of a continuous specialized services program.
Specialized Service Array provided/arranged for by NF
l
Maintenance-focused physical therapy, occupational therapy, speech therapy
l
Customized manual wheelchair
l
Durable medical equipment
Specialized Service Array provided/arranged for by LIDDA
S ervice coordination, including alternate placement services
l Employment assistance
l Supported employment
l Day habilitation
l
64
l
Independent living skills training
l
Behavioral support
Section II
F residents who have an intellectual or developmental disability as determined by a preadmission
N
screening and resident review (PASRR) evaluation and have been determined to meet medical
necessity criteria.
l
l
— Statutory Authority. Social Security Act §§ 1905(a)(4)(A) and 1919(a) [42 U.S.C. §§ 1396d(a)(4)(A) and
1396r(a)]; Texas Human Resources Code chapter 32 and § 161.071(2).
— Rules. Title 40 TAC. Chapter 19.
Nursing Facility Program • Statistics
FY 2014
FY 2015
55,954
31,077
$135.76 $143.61
Average amount of individual income applied to the cost of care per day
$24.45 $25.19
Net nursing facility cost per Medicaid resident per month
$3,386
$3,579
Average number receiving personal needs allowance per month
13,460
13,460
Average monthly cost per recipient of personal needs allowance
$30.00
$30.00
Average number receiving Medicaid-funded services per month
Average daily nursing home rate
Medicaid-Funded Nursing Facility Services • Monthly Averages
by Region
Number Percent of
Region
of Recipients
State Total FY2015• Monthly Average
Number Percent of
of Recipients
State Total
1 Lubbock
2,407.00 4.30%
1,334
4.30%
2 Abilene
2,417.00 4.30%
1,334
4.30%
13,479.00 24.10%
7,594
24.40%
4 Tyler
4,772.00 8.50%
2,702
8.70%
5 Beaumont
3,091.00 5.50%
1,705
5.50%
3 Grand Prairie
6 Houston
8,65215.50%
4,77615.40%
7 Austin
7,11412.70%
3,90212.60%
8 San Antonio
6,929
3,761
9 Midland
1,5612.80%
10 El Paso
11 Edinburg
State Total
939
12.40%
1.70%
4,5928.20%
55,954100.00%
12.10%
9082.90%
548
1.80%
2,5148.10%
31,077100.00%
65
Medicare Skilled Nursing Facility (SNF)
DADS
l
Medicaid pays the Medicare Skilled Nursing Facility (SNF) coinsurance for people who are eligible for Medicaid in Medicare
(XVIII) facilities. Medicaid also pays the co-payment for those
determined to be a Medicaid Qualified Medicare Beneficiary (QMB),
and for those who are determined to be a “pure” (i.e., Medicareonly) QMB. For residents of facilities certified for both Medicaid and
Medicare, Medicaid pays the co-insurance, less the applied income
amount for residents who are both Medicaid only and Medicaid
QMB. For residents who are “pure” QMB, the entire co-insurance
amount is paid. The amount of Medicare co-insurance per day is set
by the federal government at one-eighth of the hospital deductible.
To be eligible for Medicaid coverage in a nursing facility, a resident must:
l
l
l
Live in a Medicaid-certified facility for 30 consecutive days.
e eligible for Supplemental Security Income (SSI) from the Social Security Administration
B
or be determined by the Texas Health and Human Services Commission to be financially
eligible for Medicaid.
Meet medical necessity requirements*.
* See the appendices for a description of the medical necessity determination process.
— Statutory Authority. Social Security Act § 1902(a)(10)(E) [42 U.S.C. § 1396a(a)(10)(E)]; Texas Human Resources
Code chapter 32 and § 161.071(2).
— Rules. Title 1 TAC. Part 15, Chapter 359
Medicare Skilled Nursing Facility • Statistics
Average number receiving nursing facility co-payments per month
Net Medicaid/Medicare co-pay per resident for nursing facility services per month
66
FY 2014
FY 2015
5,410
3,687
$2,271.1
$2,324.23
Section II
Number Percent of
Region
of Recipients
Number Percent of
of Recipients
State Total
1 Lubbock
195
2 Abilene
2214.10%
3 Grand Prairie
1,273
3.60%
23.50%
131
3.60%
1514.10%
886
24.00%
4 Tyler
4939.10%
3339.00%
5 Beaumont
2975.50%
2155.80%
6 Houston
91817.00%
61316.60%
7 Austin
5219.60%
3649.90%
8 San Antonio
605
420
9 Midland
1342.50%
952.60%
10 El Paso
118
90
11 Edinburg
63411.70%
39010.60%
5,410100.0%
3,687100.0%
State Total
by Region
l
Nursing Facility Co-payments • Monthly Averages
11.20%
2.20%
11.40%
2.40%
Hospice
A program of palliative care that allows for care to be provided at the recipient’s home and consists of
medical, social and support services to a terminally ill patient, when curative treatment is no longer
possible. Recipients must be eligible for Medicaid and must have a physician’s prognosis of six months
or less to live if the terminal illness runs its normal course. Eligible recipients 21 or older must agree to
waive Medicaid payment for services related to the terminal illness.
Services include:
l Physician services and nursing care.
l Medical social services.
l Counseling.
l Home health aide services.
l Homemaker and household services.
l Physical, occupational or speech language pathology services.
l B ereavement counseling.
l Medical appliances and supplies.
l Drugs and biologicals.
l Volunteer services.
l General inpatient care (short-term).
l Respite care.
67
Service settings can be in the home, in a community-based residential location or in a long-term
care facility.
DADS
l
Medicaid rates for Community-based Hospice are based on Medicare rates set by the Centers for
Medicare & Medicaid Services (CMS). For residents of a nursing facility receiving hospice services,
the nursing facility also receives a payment of no less than 95 percent of the established nursing facility
room and board rate.
l
Hospice is for all age groups, including children, during their final stages of life.
— Statutory Authority. Social Security Act § 1905(a)(18) [42 U.S.C. §§ 1396d(a)(18)]; Texas Human Resources
Code chapter 32 and § 161.071(1) and (2).
— Rules. 42 C.F.R. part 418; Title 40 TAC. Chapter 30
Hospice Services • Statistics
FY 2014
FY 2015
6,918
7,084
$2,862.70 $3,020.63
Average net payment per recipients per month
Hospice Services • Monthly Averages
by Region
Number Percent of
Region
of Recipients
3545.10%
3434.80%
2 Abilene
3555.10%
3494.90%
3 Grand Prairie
1,908
27.60%
1,932
27.30%
4 Tyler
70810.20%
70710.00%
5 Beaumont
3935.70%
4155.90%
6 Houston
79811.50%
82611.70%
7 Austin
83312.00%
85612.10%
8 San Antonio
802
836
9 Midland
2043.00%
1962.80%
10 El Paso
117
116
11 Edinburg
4446.40%
State Total
11.60%
1.70%
6,918100.00%
68
Number Percent of
of Recipients
State Total
11.80%
1.60%
5087.20%
7,084100.00%
Section II
l
by Providing Community-based Individual Services
In January 2000, Texas implemented a Promoting Independence
Initiative, developed in response to the U.S. Supreme Court ruling in
Olmstead v. L.C. and Executive Orders GWB 99-2 (1999).
The court ruled in June 1999 that states must provide communitybased services to people with disabilities in state institutions who would
otherwise be entitled to institutional services when:
l
l
l
The state’s treatment professionals determine that such placement
is appropriate.
The affected do not oppose such treatment.
e placement can be reasonably accommodated, taking into account
Th
the resources available to the state and the needs of others who are
receiving state-supported disability services.
Senate Bill (S.B.) 367, 77th Legislature, Regular Session, 2001, codified the initiative and included:
l
l
l
The creation of a statewide advisory committee (Promoting Independence Advisory Committee).
required annual status report submitted by this advisory committee to the executive commissioner
A
of the Texas Health and Human Services Commission (HHSC).
revised Promoting Independence Plan submitted by the executive commissioner of HHSC to the
A
governor and the Legislature prior to the legislative session (the most recent Promoting Independence
Plan can be found at www.dads.state.tx.us/providers/pi/index.html).
S.B. 367 directed that HHSC have responsibility for the initiative because it involves all of the health
and human services operating agencies; Gov. Rick Perry’s Executive Order RP-13 (2002) added the
Texas Department of Housing and Community Affairs and the Texas Workforce Commission to the
Promoting Independence Advisory Committee.
Administration of the Initiative
Texas’ Promoting Independence Initiative supports allowing Texans with disabilities to make a choice in
the residential setting where they want to receive their long-term services and supports, which is often
the most integrated residential setting available.
Among the many goals of the initiative, the following continue to have a significant impact:
l
l
l
roviding opportunities for residents of state supported living centers to move to a community
P
alternative within 180 days of their request and recommendation for movement to a community-based
living arrangement.
roviding opportunities for residents of intermediate care facilities for people with an intellectual
P
disability (ICF/IID) that serve nine or more residents to move to an alternative living arrangement
within 12 months of their request to relocate into a community-based living arrangement.
roviding opportunities for people with IDD who are aging out of the Texas Department of Family
P
and Protective Services (DFPS) foster care system; living in DFPS’ General Residential Operations
69
facilities; or living in nursing facilities to enroll in the Home and
Community-Based Services (HCS) waiver.
l
l
DADS
l
l
Providing opportunities for children living in small ICF/IID
to enroll in the HCS waiver.
roviding opportunities for residents of Medicaid-certified
P
nursing facilities to move to a community-based integrated living
arrangement without going on a waiver interest list (Money
Follows the Person).
roviding intensive services for people with three or more state
P
mental hospital facility admissions within a 180-day period.
Community Living Options Information Process (CLOIP)
In 2000, the Community Living Options process was implemented
for residents of large ICF/IID. This process provides information
to individuals and their legally authorized representatives about alternative settings in which they can
receive services. It includes a review of residents’ goals and identification of individuals who indicate a
preference for a residence outside the institutional setting. Anyone who indicates a desire for alternative
services is referred to the local intellectual and developmental disability authority (LIDDA) to receive
more information about services for which they may be eligible.
Senate Bill. 27, 80th Legislature, Regular Session, 2007, directed DADS to delegate to LIDDAs the
Community Living Options function for adult residents at state supported living centers. This process
was renamed the Community Living Options Information Process (CLOIP). This legislation required
the development of an effective CLOIP, creation of uniform procedures for the implementation of the
CLOIP to minimize any potential conflict of interest between a state supported living center and an
adult resident, an adult resident’s legally authorized representative or a LIDDA. The process was fully
operational by January 2008.
Relocation Services
In order to support the relocation activities of those leaving an institution, the following support
activities were developed:
l
l
l
l
70
elocation specialists help identify nursing facility residents wanting to relocate into the community
R
and facilitate their relocation.
ransition assistance services stipends up to $2,500 help nursing facility residents enrolling in a
T
Medicaid waiver program establish a new household.
e project access program helps establish links to Section 8 housing voucher options for residents
Th
leaving a nursing facility who do not have a community residence.
ommunity transition teams, local public-private entities, help identify barriers to relocation and
C
promote systemic changes to overcome those barriers.
Section II
l
Residents eligible for Medicaid who live in a nursing facility or ICF/IID can request services in the
community. To take advantage of this opportunity, the resident must live in an institutional setting
until a written eligibility determination approves specific community services and indicates when those
services will begin.
— Statutory Authority. Social Security Act Title XIX [42 U.S.C. §§ 1396-1396w-2]; Texas Government Code
§§ 531.0244-531.02443, § 531.082, and chapter 531, subchapter D-1; Texas Human Resources Code
§ 161.071(1).
— Rules. Title 40 TAC. §§ 48.2721-48.2725 Part 1, Chapter 48 and Chapter 62
Promoting Independence – Community-based Services • Statistics
Average cost per recipients per month
FY 2014
FY 2015
4,902
3,096
$1,412.27 $1,445.39
71
DADS
l
Intermediate Care Facilities –
Individuals With Intellectual
Disability Services
Intermediate care facilities provide residential
services and supports for people with intellectual
or developmental disabilities (ICF/IID).
Intermediate Care Facilities – IID Services
An intermediate care facility for individuals with
intellectual or developmental disabilities or related
conditions (ICF/IID) is a residential facility serving
four or more people with intellectual and developmental disabilities. Providing active treatment is the
core requirement of certification as an ICF. Active treatment is the aggressive, consistent implementation
of a program of specialized and generic training, treatment and health services. Active treatment does
not include services to maintain generally independent residents who are able to function with little
supervision or in the absence of a continual active treatment program.
Section 1905(d) of the Social Security Act created this optional Medicaid benefit to certify and
fund these facilities. Each facility must comply with federal and state standards, applicable laws and
regulations. ICF/IID are operated by both private and public (community centers and a state agency)
entities. These facilities provide diagnosis, treatment, rehabilitation, ongoing evaluation, planning,
24-hour supervision, coordination and integration of health or rehabilitative services to help residents
function at their greatest capacity.
To be eligible for the ICF/IID Program, a person must:
l
ave a diagnosis of ID with a full-scale intelligence quotient (IQ) score of 69 or below, as determined
H
by a standardized individual intelligence test, and have an adaptive behavior level with mild to extreme
deficits as determined by a standardized assessment.
OR
l
ave a full-scale IQ score of 75 or below, a primary diagnosis by a licensed physician of a related
H
condition (manifesting before age 22), and an adaptive behavior level with mild to extreme deficits as
determined by a standardized assessment.
OR
l
72
ave a primary diagnosis of a related condition (manifesting before age 22) diagnosed by a licensed
H
physician, regardless of IQ, and have an adaptive behavior level with moderate to extreme deficits as
determined by a standardized assessment.
Section II
l
e in need of and able to benefit from the active treatment provided in the 24-hour supervised
B
residential setting of an ICF.
l
l
AND
e eligible for Supplemental Security Income (SSI) or be determined to be financially eligible
B
for Medicaid by the Texas Health and Human Services Commission.
— Statutory Authority. Social Security Act § 1905(d)(15) [42 U.S.C. §§ 1396d(15)]; Texas Human Resources
Code § 161.071(2).
— Rules. Title 40 TAC. Chapter 9, Subchapter E.
Intermediate Care Facilities – IID Services • Statistics
FY 2014
FY 2015
Average number of people in ICF Medicaid beds per month
5,422
5,092
Average number of ICF Medicaid beds per month
5,954
5,835
$4,337.16
$4,335.07
Average monthly cost per Medicaid-eligible ICF resident
Data Sources: DADS Operating Budget FY 2016• DADS Program Areas
73
People in ICF/IID Medicaid Beds • Monthly Averages
l
DADS
ACCESS
Andrews Center
Border Region Behavioral Health Center
Burke Center
Denton County MHMR
El Paso MHMR Center
Gulf Bend Center
Gulf Coast Center
LifePath Systems
Metrocare Services
Spindletop Centers
Texana Center
Tri-County Services
West Texas Centers
State Total
Data Sources: Claims Management System Payment Data • DADS Program Area
74
FY 2014
FY 2015
6763
544
504
104
103
266
249
179
174
331
316
0
0
116
112
0
0
46
46
45
40
11
12
24
16
235
216
181
170
73
65
22
18
42
42
38
34
85
75
263
256
148
138
30
29
276
270
18
19
548
531
78
77
503
470
107
95
212
198
96
87
170
164
170
121
90
84
52
52
46
42
44
42
121
121
41
41
5,422
5,092
Section II
l
State Supported Living
Centers Services
DADS provides specialized assessment, treatment, support and
health care services in state supported living centers for people
with intellectual and developmental disabilities.
State Supported Living Centers (SSLC) Services
This program provides direct services and supports for
people at 12 SSLCs and the Rio Grande State Center. These
centers provide campus-based intellectual and developmental
disability residential services along with mental health services.
SSLCs are located in Abilene, Austin, Brenham, Corpus Christi, Denton, El Paso, Lubbock, Lufkin,
Mexia, Richmond, San Angelo and San Antonio. The Rio Grande State Center, located in Harlingen, is
operated by the Texas Department of State Health Services (DSHS). DADS has contracted with DSHS to
provide services at this location.
Each center is certified as an intermediate care facility for individuals with an intellectual disability or a
related condition (ICF/IID), a Medicaid-funded federal/state service. Approximately 60 percent of the
operating funds for the facilities are received from the federal government, and 40 percent are provided
through state general revenue or third-party revenue sources.
These facilities provide 24-hour residential services, comprehensive behavioral treatment and health
care, including medical, psychiatry, nursing and dental services. Other services include skills training;
occupational, physical and speech therapies; adaptive aids; day habilitation; vocational programs and
employment; and participation in community activities and services to maintain connections between
residents and their families or natural support systems.
Residential services in an SSLC serve people with severe or profound intellectual disabilities and those
with intellectual disabilities who have significant medical or behavioral health needs.
Local intellectual and developmental disability authorities (LIDDAs) serve as the point of entry
for SSLCs and certain other publicly funded services and supports for persons with intellectual
or developmental disabilities. The LIDDA performs a diagnostic assessment to help determine an
individual’s eligibility for admission to an SSLC.
— Statutory Authority. Texas Health and Safety Code § 533.038 and chapter 555; Texas Human Resources Code
§ 161.071(2)
— Rules. Title 40 TAC. Part 1. Chapter 2, Subchapter F; Chapter 3; Chapter 5, Subchapters A, C, and I; Chapter 7,
Subchapter C.
75
State Supported Living Centers • Statistics FY 2014
FY 2015
3,441
3,241
$16,595.66 $17,361.51
FY 2014
FY 2015
l
Average number of ID campus residents per month
DADS
Average cost per ID campus resident per month
Data Sources: DADS Operating Budget FY 2016 • DADS Program Areas
Number of SSLC Campus Residents • Monthly Averages
State Supported Living Center
Abilene
368336
Austin
279223
Brenham
287283
Corpus Christi
233
Denton
467456
El Paso
114
Lubbock
205202
Lufkin
336318
Mexia
300255
Richmond
335330
San Angelo
212
209
San Antonio
240
231
Rio Grande
65
69
3441
3,241
Total Residents
Data Sources: Claims Management System Payment Data • DADS Program Areas • Care Data System • Client Assignment Registration System
76
223
106
Section II
l
For DADS, funding in this strategy is for the construction and renovation at the state supported living
centers (SSLC) and state-owned bond homes for people with intellectual and developmental disabilities.
The vast majority of projects funded and underway are to bring facilities into compliance with the
requirements in the Life Safety Code or make other critical repairs and renovations, including fire
sprinkler systems, fire alarm systems, emergency generators, fire/smoke walls, roofing, air conditioning,
heating, electrical, plumbing, etc.
The large number of buildings on SSLC campuses and the age of many of these buildings necessitate
ongoing capital investments to ensure that they are functional, safe and comply with all pertinent
standards. Compliance with such standards is mandatory to avoid the loss of federal funding for the
state facilities.
77
l
Regulation, Certification
and Outreach
DADS
DADS provides licensing, certification or contract enrollment
services, as well as financial monitoring and complaint
investigation, to ensure that service providers in facilities or
home settings comply with state and federal standards and that
residents receive high-quality services and are protected from
abuse, neglect and exploitation. These include nursing facilities,
assisted living facilities, day activity and health services (DAHS)
facilities, intermediate care facilities for individuals with intellectual disabilities or a related condition
(ICFs/IID), home and community support services agencies (HCSSA) and providers of Home and
Community-based services waiver and Texas Home Living waiver services.
According to the Texas Health and Safety Code, Chapters 142, 242, 247, 248A and 252, and the Texas
Human Resources Code, Chapter 103, all long-term care facilities and agencies that meet the definition
of nursing facilities, prescribed pediatric extended care centers, assisted living facilities, day activity
health services facilities, privately owned ICFs/IID and HCSSAs must be licensed and maintain
compliance with all applicable licensure rules in order to operate in Texas.
Licensed facilities or agencies wishing to participate in the Medicare or Medicaid programs must be
certified and comply with certification regulations according to Titles XVIII and/or XIX of the Social
Security Act. Government-owned/operated ICFs/IID and hospital-based skilled nursing facilities are
also required to be certified to participate in Medicare or Medicaid.
Types of regulated programs
Nursing Facility – DADS licenses and certifies nursing facilities that serve people through Medicare and
Medicaid. DADS also conducts an annual survey and licensing inspection, investigates complaints
and provider self-reported incidents, and monitors facilities that are out of compliance with state and
federal regulations.
Most nursing facility residents are elderly; a small number are children or young adults. Many residents
enter a nursing facility to recuperate after surgery or receive rehabilitation after a stroke or a hip fracture.
Some residents leave the facility shortly after admission; others remain for the rest of their lives. In
some cases, residents return to their homes or to a lower level of care in the community; in other cases,
residents may need hospitalization. Most residents need help with one or more basic activities of daily
living, such as dressing and grooming, bathing, toileting, getting into and out of bed, and eating. Many
residents have dementia, periods of confusion or memory impairments. All residents have a plan of care
directed by a physician and require licensed nursing supervision 24 hours a day.
Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) – All privately owned/
operated non-government owned/operated facilities must be licensed by DADS. All ICFs/IID serving
Medicaid recipients must be certified. DADS conducts annual survey and licensing inspections,
78
Section II
l
investigates complaints and provider self-reported incidents, and monitors facilities that are out of
compliance with regulations.
All residents must have a diagnosis of an intellectual or developmental disability or a related condition.
Some may be unable to move without the assistance of a wheelchair or other mobility device. Some
have seizure disorders, maladaptive behavior problems, mental illness, visual or hearing impairments,
or a combination of these. All must be financially eligible for Medicaid. People of any age may receive
services in a ICFs/IID.
Assisted Living Facility – DADS is responsible for licensing these facilities, conducting licensure
inspections every two years, investigating complaints and self-reported incidents, and monitoring
facilities that are out of compliance with regulations.
The average resident may:
l Exhibit symptoms of mental or emotional disturbance but is not considered at risk of imminent harm
to self or others.
l Need assistance with movement.
l Require a therapeutic diet.
l Require assistance with bathing, dressing and grooming.
l Require assistance with routine skin care, such as application of lotions or treatment of
minor cuts and burns.
l Need reminders to encourage a toilet routine and prevent incontinence.
l Require temporary services by professional personnel.
l Need assistance with medications, supervision of self-medication or administration of medication.
l Require encouragement to eat or monitoring due to social or psychological reasons or
temporary illness.
l B e hearing or speech impaired.
l B e incontinent without pressure sores.
l Require self-help devices.
l Need assistance with meals, which may include feeding.
Day Activity and Health Services Facility – DADS licenses these facilities, conducts licensure inspections
every two years, investigates complaints and provider self-reported incidents and monitors facilities that
are out of compliance with regulations.
Licensing rules do not provide a description of consumers who are appropriate for day activity and
health services facilities. Per the facility contract, the average consumer may need day services
for the following:
l Assistance with bathing, dressing, and routine hair and skin care.
l Assistance transferring from a chair or walking.
l Assistance with toileting.
l Assistance with meals.
l Assistance with fluid intake.
l A therapeutic diet.
l Supervision or administration of ordered medications.
79
reatments (e.g., application of sterile dressings, bandages).
T
Restorative nursing procedures (range of motion exercises or proper positioning).
l Assistance with management of behavioral problems.
l
l
DADS
l
Home and Community Support Services Agency (HCSSA) – DADS licenses home health and hospice agencies
and can make recommendations to the Centers for Medicare & Medicaid Services regarding an agency’s
initial certification and its ongoing participation in the Medicare program. DADS also investigates
complaints and provider self-reported incidents.
An HCSSA (home health, hospice or personal assistance services) consumer may be an adult of any
age, a child or an infant receiving care in their home, place of residence or in-patient hospice facility.
Waiver Programs – DADS Regulatory Services conducts initial and annual on-site certification reviews
of the Home and Community-based Services (HCS) waiver contracts and the Texas Home Living
(TxHmL) waiver contracts. DADS Regulatory Services also receives complaints from DADS Consumer
Rights and Services related to HCS and TxHmL services. DADS receives and follows up on Texas
Department of Family and Protective Services (DFPS) findings related to abuse, neglect or exploitation
investigations of recipients of HCS or TxHmL services.
The HCS recipient has intellectual or developmental disabilities and may be non-ambulatory or have
seizure disorders, behavior problems, mental illness, visual or hearing impairments, or a combination
of these conditions.
The TxHmL recipient has intellectual and developmental disabilities, may have other disabilities
and must be financially eligible for Medicaid.
Prescribed Pediatric Extended Care Center (PPECC) – Starting Jan. 1, 2015, DADS became authorized to
license prescribed pediatric extended care centers. A PPECC will function as a non-residential facility
operated for profit or on a nonprofit basis that provides physician-prescribed services to seven of more
medically dependent or technologically-dependent minors, ages birth to 21 years. The maximum
capacity for a PPECC cannot exceed 60 minors. A minor can receive up to 12 hours of basic services
per day including:
l Medical
l Nursing
l Psychosocial
l Therapeutic
l Developmental
— Statutory Authority. Social Security Act §§ 1864, 1902(a)(9) and (33), and 1919(g) [42 U.S.C. §§ 1396a(a)(9)
and (33) and 1396r(g)]; Texas Health and Safety Code chapters 142, 242, 247 and 252; Texas Human Resources
Code chapter 48, chapter 103, and § 161.071(1), (6), (7), (8) and (9); and § 161.076 (as added by Acts 2009,
81st Leg., ch. 284, § 37 [S.B. 643]).
— Rules. 42 C.F.R. parts 483, 484, 488 and 498; Title 40 TAC. Chapters 19, 30, 90, 92, 96, 97, 98 and 99.
80
Section II
FY 2014
FY 2015
4,031
4,237
17,944
18,827
HCSSA licenses issued (two-year license)
3,255
3,349
HCSSA inspections completed
1,291
1,193
HCSSA investigations completed
2,479
2,696
HCS/TxHmL certification surveys conducted
1,364
1,305
88
65
HCS/TxHmL follow-ups to findings related to abuse, neglect or exploitation
3,614
3,467
ICFs/IID follow-ups to findings related to abuse, neglect or exploitation
3,447
3,769
12,471 11,535
Facility inspections completed
Facility investigations completed
HCS/TxHmL complaints requiring regulatory follow-up
HCS residential reviews Programs and Services
l
Regulation • Statistics
Data Sources: Regulatory Services Central Data Repository • Regulatory Services Waiver Survey & Certification Report Log, Complaint, and ANE Databases• Regulatory Services Sunset Report
Number of Facilities/Agencies Regulated
by
Region • FY 2015
Region
Home and Community
Nursing Intermediate
Assisted Living
Adult Day Care
Support Services
Facilities
Care FacilitiesFacilitiesFacilities
Agencies
1 Lubbock
73
34
86
6
160
2 Abilene
75
42
51
1
137
3 Grand Prairie
274
215
538
39
1,815
4 Tyler
101
71
97
9
285
84
48
48
9
194
6 Houston
167
125
461
50
1,733
7 Austin
147
112
173
5
440
8 San Antonio
158
120
254
54
535
9 Midland
42
34
27
2
89
10 El Paso
16
14
41
29
174
11 Edinburg
86
32
53
277
781
1,223
847
1,829
481
6,343
5 Beaumont
State Total
Data Source: DADS Fiscal Year 2015 Regulatory Services Annual Report • Regulatory Services Sunset Report
81
Facility and Community-based Regulation • Statistics
DADS
l
Facilities/Agencies Regulated
Nursing facilities
ICFs/IID
Assisted living facilities
Day activity and health services
Home and community support services agencies (total)
Home health and hospice parent agencies
Home health branches
Alternate delivery sites (hospice branches)
Complaint and Incident Intakes
Nursing facilities
ICFs/IID
Assisted living facilities
Unlicensed facilities
Day activity and health services Home and community support services agencies
Total
FY 2014
FY 2015
1,224
1,223
863847
1,771
1,829
478
481
6,352
6,343
5,413
5,426
769
730
170
187
20,437
22,421
1,2071,178
3,296
3,548
306
289
797
657
7,219
7,282
33,17235,375
Enforcement Actions – Nursing Facilities
Proposed action to deny or revoke license
Administrative penalties imposed
Civil Monetary penalties imposed
Referrals to the attorney general for civil penalties
Emergency closure and suspension of license
Suspension of admissions
Facilities under trusteeship
Facilities closed by trustee
6
39
294
1
0
0
0
0
11
40
271
2
2
0
0
0
Enforcement Actions – ICFs/IID
Proposed action to deny or revoke license
Referrals to the attorney general for civil penalties
Suspension of license
6
0
1
0
0
26
2
0
0
0
Enforcement Actions – Assisted Living Facilities
Proposed action to deny or revoke a license
Referral to attorney general for civil penalties or injunctive/other relief
Facilities closed by trustee
60
34
9
0
0
41
36
6
0
0
Enforcement Actions – Unlicensed Facilities
Referral to attorney general for civil penalties or injunctive/other relief
Relief referral to cnty/dist. attorney for civil penalties or injunctive/other relief
15
0
22
1
Enforcement Actions – Day Activity and Health Services
Proposed action to revoke or deny a license
Referral to attorney general for injunctive/other relief
Emergency suspension of license and closing order
16
9
0
0
20
11
0
0
545
135
0
31
8
13
0
741
123
0
27
10
10
0
Enforcement Actions – Home and Community Support Services Agencies
Recommended action to revoke a license
Recommended emergency suspension of license
Surrender of license in lieu of further action
Expiration of license in lieu of further action
Recommended denial of license renewal
Referrals to attorney general for civil penalties or injunctive relief
Data Sources: Annual Report FY 2015
82
Section II
l
Under the authority of federal and state law, DADS licenses, certifies, permits and monitors
applicants for the purpose of employability in facilities and agencies regulated by DADS through
four credentialing programs:
Nursing Facility Administrator Licensing and Enforcement – Responsibilities include licensing and
continuing education activities; investigating complaints or referrals; coordinating sanction
recommendations and other licensure activities with the governor-appointed Nursing Facility
Administrators Advisory Committee; imposing and monitoring sanctions; providing due process
considerations; and developing educational, training and testing curricula.
Nurse Aide Registry and Nurse Aide Training and Competency Evaluation Program (NATCEP) – Responsibilities
include nurse aide certification and sanction activities; approving or renewing NATCEPs; withdrawing
NATCEP approval; and providing due process and a determination of nurse aide employability in
nursing facilities regulated by DADS via the Nurse Aide Registry.
Employee Misconduct Registry (EMR) – Responsibilities include providing due process and a determination
of unlicensed staff employability in facilities and agencies regulated by DADS via the EMR.
Medication Aide Program – Responsibilities include continuing education; issuing and renewing
medication aide permits; imposing and monitoring sanctions; providing due process; approving and
monitoring medication aide training programs in educational institutions; developing educational,
training and testing curricula; and coordinating and administering examinations.
— Statutory Authority. Social Security Act § 1919 [42 U.S.C. § 1396r]; Texas Health and Safety Code chapter 142,
subchapter B; chapter 242, subchapter I (as added by Acts 1997 75th Leg., ch. 1280, § 1.01) and subchapter N;
chapter 250; and chapter 253; Texas Human Resources Code § 161.071(6) and (9).
— Rules. Title 40 TAC. Chapter 18, 93, 94, and 95.
Statewide Credentialing / Certification • Statistics
Nursing facility administrators licensed
Disciplinary actions imposed
Nurse aides certified
Nurse aide training and competency evaluation programs approved
Medication aides permitted
Medication aide training programs conducted
Persons on employee misconduct registry
FY 2014
FY 2015
2,057
2,127
40
62
127,709
114,715
44
98
783
838
9,977
9,835
6
6
158
158
3,002
3,441
25
61
Data Sources: Regulatory Credentialing Enforcement • DADS Fiscal Year 2015 Regulatory Services Annual Report
83
Long-Term Services and Supports
Quality Outreach
DADS
l
The Quality Monitoring Program and Quality
Reporting sections of the Center for Policy and
Innovation perform a variety of functions to
enhance the quality of services and supports.
Major initiatives are described below.
The Quality Monitoring Program (QMP)
QMP takes an educational rather than regulatory
approach to quality improvement. QMP staff, who
are nurses, pharmacists and dietitians, perform
assessments of a facility’s systems of care and provide technical assistance to facility staff. In addition,
they provide in-service education programs. The technical assistance visits focus on specific, statewide
quality improvement priorities for which evidence-based best practices can be identified from published
clinical research.
During each quality monitoring visit, monitors evaluate the use of antipsychotic medications,
particularly in residents with dementia. Other best practice topics that might be evaluated during
a visit include:
l Restraint reduction.
l Improving vaccination rates.
l Enhancing advance-care planning.
l Improving fall-risk management.
l Decreasing inappropriate use of artificial nutrition and hydration.
l Improving routine hydration practices and preventing unintended weight loss or weight gain.
l Improving pain assessment and management.
l Improving the appropriate use of anti-psychotic medication.
l Preventing pressure ulcers.
l Improving medication safety.
l Improving the care of residents with dementia.
l Strengthening documentation practices of nurses and CNAs.
l Improving the facility’s infection control program.
l Evaluating the facility’s Preadmission Screening and Resident Review (PASRR) processes.
QMP has led to measurable statewide improvements in the quality of life of residents of nursing
facilities. With the help of the quality monitors, facilities have reduced the use of restraints and have
seen modest improvements in the proportion of residents with unintended weight loss. In addition, the
proportion of residents who received anti-psychotic medications has decreased from over 28% in 2011
to less than 22% in July 2015.
A related website, www.dads.state.tx.us/providers/qmp/, supports the program by providing online access
to best-practice information and links to related research.
84
Section II
l
Number of quality monitoring visits to nursing facilities
Average cost per visit
FY 2014
FY 2015
3,148
2,176
$1,035
$1,554
Long-Term Care Quality Outreach • Statistics
Note: Data reflects the number of visits, regardless of the number of monitors and/or the number of days involved.
Rapid Response Teams
Facilities that require extra assistance to improve one or more of their services will be visited by a rapid
response team. These visits usually involve more than one quality monitor and could consist of any
combination of nurses, dietitians and pharmacists. This allows for flexibility and provides the team with
a broader view of the facility’s resident care systems. The regional regulatory liaison may be part of the
team, with Ombudsman staff and other professionals assisting the team as needed.
These teams help nursing facilities improve and provide accurate, timely services and supports. The visit
encourages learning and team building, which promotes positive relationships with providers through
the use of diverse teaching techniques.
— Statutory Authority. Texas Health and Safety Code chapter 255 Quality Assurance EARLY Warning System
for Long-Term Care Facilities; Rapid Response Teams
Quality Review
DADS also administers multiple long-term services and
support programs for the aging, for people with intellectual
and developmental disabilities (IDD) and for people with
physical disabilities. CPI staff conduct two large-scale surveys:
l
l
e Nursing Facility Quality Review is a statewide survey
Th
used to benchmark the quality of care and quality of life of
Texas nursing facility residents across the state.
e Long-Term Services and Supports Quality Review
Th
(LTSS) is a statewide survey of people receiving services
and supports through home and community-based and
institutional programs offered by DADS. This survey
describes the perceived quality and adequacy of long-term
services and supports, consumer quality of life, and trends
in long-term services and supports over time.
The quality review process has been in effect since 2005 as an
activity of a Real Choice Systems Change Grant awarded by
the Centers for Medicare & Medicaid Services (CMS).
85
The review is not regulatory in nature, but rather a method to identify areas in need of improvement.
DADS
l
People receiving services and supports, or their family members and guardians, provide valuable
feedback through face-to-face and mailed interviews. These surveys obtain the individuals’ perspective
about their lives, services and supports. The LTSS survey provides baseline information for continuous
quality improvement, monitoring and intervention, and helps the agency build a quality management
strategy, identify trends, develop innovations and provide information to stakeholders and CMS.
The LTSS survey uses three nationally recognized survey instruments designed for measuring specific
consumer indicators:
l
National Core Indicators Adult Consumer (NCI)
l
National Core Indicators Child and Family Survey (CF) for the I/DD population
l
Participant Experience Survey Elderly/Disabled (PES) version for the elderly disabled
Data are collected on the following broad domains:
l
Services satisfaction
l
Systems performance
l
Health and welfare
l
Individual choice and respect
l
Work and community inclusion
From these surveys and other data, CPI staff have developed the Long-Term Services and Supports
Quality Reporting System (QRS) website, which allows the public to view, evaluate and compare the
quality of long-term services and supports providers. The QRS website continues to evolve as new
information within the purview of DADS is added.
86
Section II
l
Indirect Administration
Central Administration
Central Administration supports administrative functions
for all DADS programs, including:
l
Executive direction and leadership.
l
Legal.
l
Civil rights.
l
Hearings of provider appeals.
l
Planning.
l
Budget management.
l
Fiscal accounting and reporting.
l
Asset management.
l
Program statistics.
l
Public information.
l
State and federal government relations.
l
Internal audit.
l
Program support.
Under the Older Americans Act, central administration supports functions such as:
l
l
l
Building system capacity to meet service needs.
Serving as a comprehensive resource on issues affecting older Texans via research,
policy analysis, public information and marketing.
Advocating for the needs of older Texans through the Long-term Care Ombudsman Program
and in partnership with public and private organizations.
In addition, Central Administration performs statewide policy and oversight of support
services, including:
l
Contract management policy.
l
Forms and handbook management.
l
Records management and storage.
l
Building maintenance.
l
Mailroom.
l
Inventory.
87
This strategy also includes direct support to staff in all programs in the state office. Although HHSC has
assumed responsibility for procurement and facility acquisition and management, DADS continues to
implement appropriate process and procedures within service level agreements.
DADS
l
— Statutory Authority. Texas Human Resources Code, Chapter 161. Texas Government Code, Chapters 2155;
and Texas Human Resources Code, Chapter 161.
Information Technology (IT).
IT provides technology products, services and support to all DADS divisions to help them achieve
the DADS mission. This responsibility extends to:
l Establishing, managing and monitoring agreements for IT products.
l Coordinating services or support supplied by external organizations.
l Coordinating all technology requests for goods and services (including technical contractors).
l Publishing technology policies and procedures in the DADS IT Handbook.
Services include:
pplication management and support.
A
l Desktop and network support and troubleshooting.
l Coordination of cabling and hardware repair, and liaison with external automation services providers
(such as mainframe and mid-tier data center processing and telecommunications services).
l
These services are distributed in a network-computing environment that spans DADS offices statewide.
Included are:
S taff costs.
l Professional services and contracted staff costs.
l Network data circuits, mainframe, mid-tier, and network equipment costs.
l Software licenses and computer equipment maintenance related to the support of DADS programs.
l
The application systems developed, deployed and supported under this strategy cover financial
systems, including:
l Revenue systems.
l Consumer information systems that support the authorization of DADS services to those who qualify.
l Facility management systems.
l Decision support systems.
l Long term services provider oversight and contracting, including certification, survey, licensing
and other regulatory information.
Functions performed include:
roject management.
P
l Software applications development and documentation.
l Determination and listing of hardware and software that can be used in the DADS environment.
l
— Statutory Authority. Texas Human Resources Code, Chapter 161, Texas Government Code, Chapter 2054.
88
Section I
l
Overview
Section III.
Demographic
and Economic Data
89
Projected Texas Population • Total and Poverty
by Region and Age Group
1 Lubbock
4 Tyler
278,200
75,000
27.0%
280,100
692,500
106,000
15.3%
697,000
202,900
22,000
10.6%
209,100
1,173,600 203,00017.3% 1,186,200
Age 0-17
Age 18-64
Age 65 +
Total
5 Beaumont
1,984,300
440,000
22.2%
2,009,800
4,672,000
616,000
13.2%
4,764,600
785,500
65,000
8.3%
821,900
7,441,8001,121,000 15.1% 7,596,300
Age 0-17
Age 18-64
Age 65 +
Total
6 Houston
Age 0-17
Age 18-64
Age 65 +
Total
Age 0-17
Age 18-64
Age 65 +
Total
7 Austin
291,300
55,000
19.0%
293,400
704,000
84,000
11.9%
707,000
177,400
17,000
9.8%
182,100
1,172,700 156,00013.3% 1,182,500
Age 0-17
Age 18-64
Age 65 +
Total
8 San Antonio
Age 0-17
Age 18-64
Age 65 +
Total
Age 0-17
Age 18-64
Age 65 +
Total
Age 0-17
Age 18-64
Age 65 +
Total
Age 0-17
Age 18-64
Age 65 +
Total
706,700
295,000
41.7%
714,500
1,345,800
337,000
25.1%
1,372,800
272,000
59,000
21.7%
282,900
2,324,500 691,00029.7% 2,370,200
Age 0-17
Age 18-64
Age 65 +
Total
7,311,900
1,813,000
24.8%
7,407,700
17,157,800
2,549,000
14.9%
17,467,300
3,225,800
347,000
10.8%
3,365,300
27,695,5004,709,000 17.0% 28,240,300
189,000
53,000
27.9%
482,800
82,000
16.9%
129,500
12,000
9.4%
801,300 147,00018.9%
190,300”
484,600
133,200
808,100
1,804,100
405,000
22.5%
1,828,100
4,307,000
559,000
13.0%
4,399,500
683,600
72,000
10.5%
719,100
6,794,7001,036,000 15.3% 6,946,700
831,100
186,000
22.3%
850,300
2,122,700
327,000
15.4%
2,166,600
375,100
29,000
7.8%
394,500
3,328,900 542,00016.3% 3,411,400
739,200
180,000
24.3%
748,100
1,749,400
258,000
14.7%
1,779,700
379,900
37,000
9.9%
395,600
2,868,500 475,00016.6% 2,923,400
254,900
73,000
28.5%
542,600
96,000
17.7%
102,800
22,000
21.2%
900,300 191,00021.2%
Data Sources: Census Bureau, 2014 American Community Survey (ACS); Texas State Data Center; and Texas Health and Human Services Commission.
Note: The sum of values may not add to total due to rounding.
90
235,800
543,300
120,400
899,500
10 El Paso 233,100
51,000
22.0%
539,000
84,000
15.6%
117,100
12,000
10.1%
889,200 147,00016.6%
11 Edinburg Age 0-17
Age 18-64
Age 65 +
Total
3 Grand Prairie 2/9 Abilene
Calendar Year 2015
Total Population
State Total
DADS
l
Region and Age Group
Calendar Year 2014
Total Population Poverty Population Poverty Percent
257,300
552,200
106,500
916,000
Section III
l
Texas Population Trends
Year
Total
Age 0-17 Age 18-64
Age 65 +
2016 Total Projected Population
28,240,300
7,407,700
17,467,300
3,365,300
27,695,500
7,311,900
17,157,800
3,225,800
2014 Total Population *
27,161,000
7,216,000
16,859,000
3,086,000
16.4%
23.9%
14.1%
11.3%
26,640,600
7,121,500
16,564,100
2,955,000
16.8%
24.2%
14.4%
12.1%
Poverty Rate
2013 Total Population *
Poverty Rate
Demographic and Economic Data
by Age Group
* Calculated for the civilian population not living in group quarters.
Data Sources: Texas State Data Center; U.S. Census Bureau - March 2015 and March 2014 Current Population Survey (CPS).
U.S. Population Trends
by Age Group
Year
Total
Age 0-17 Age 18-64
Age 65 +
324,000,000
74,000,000
201,000,000
49,000,000
321,363,000
74,518,000
199,150,000
47,695,000
2014
Total Projected Population*
319,000,000
74,000,000
199,000,000
46,000,000
14.8%
21.1%
13.5%
10.0%
314,000,000
74,000,000
197,000,000
43,000,000
14.5%
19.9%
13.6%
9.5%
Poverty Rate
2013
Total Projected Population*
Poverty Rate
*Calculated for the civilian population not living in group quarters.
Data Sources: US Census Bureau 2014 National Population Projections; U.S. Census Bureau - March 2015 and March 2014 Current Population Survey (CPS).
91
2016 Texas Population
by Region and Race
White
African American Hispanic
Other
1 Lubbock
476,200
“47,600
340,200
35,500
2/9 Abilene
668,100
“59,100
419,800
35,500
3,563,500
“1,103,500
2,281,200
648,200
4 Tyler
776,800
“180,900
191,600
36,900
5 Beaumont
493,600
“159,900
124,900
29,800
6 Houston
2,483,800
“1,144,400
2,673,000
645,400
7 Austin
1,842,600
“325,600
1,010,800
232,300
8 San Antonio
1,007,200
“163,600
1,634,300
118,300
10 El Paso
108,300
“22,000
764,500
21,300
11 Edinburg
309,600
“24,200
1,999,000
37,500
State Total
11,729,700
3,230,800
11,439,300
1,840,700
DADS
l
Region
3 Grand Prairie
Data Sources: Texas State Data Center; and Texas Health and Human Services Commission..
2016 Texas Population
by Region and Sex
Region
1 Lubbock
455,600
443,900
2/9 Abilene
601,800
580,700
3,753,400
3,842,900
4 Tyler
596,000
590,100
5 Beaumont
410,000
398,200
6 Houston
3,468,000
3,478,600
7 Austin
1,699,300
1,712,100
8 San Antonio
1,448,200
1,475,200
447,100
468,900
11 Edinburg
1,168,400
1,201,800
State Total
14,047,800
14,192,400
3 Grand Prairie
10 El Paso
Note: Sums may not add up exactly to total due to rounding.
Data Sources: Texas State Data Center; and Texas Health and Human Services Commission.
92
MaleFemale
Section III
2016 Texas Aged and Disabled (A&D) Population*
Total A&D Population
Percent of
State Total A&D Population Below Poverty
Percent of
State Total
1 Lubbock
98,0003.6% 32,0003.6%
2/9 Abilene
298,0005.5% 41,0004.6%
3 Grand Prairie
1,294,000
23.8%
182,000
20.6%
4 Tyler
326,0006.0% 54,0006.1%
5 Beaumont
225,0004.1% 36,0004.0%
6 Houston
1,148,00021.1% 178,00020.1%
7 Austin
628,000
11.6%
84,000
9.5%
8 San Antonio
656,000
12.1%
106,000
12.0%
10 El Paso
187,000
3.4%
45,000
5.1%
11 Edinburg
475,000
8.7%
129,000
14.5%
State Total
Region
l
by Region and Poverty Status
5,434,000100% 887,000100%
* The older population includes individuals 65 and older. The disabled population includes individuals under 65 with one or more limitations in a functional
activity or a social role.
Data Sources: Census Bureau, 2014 American Community Survey (ACS), Public Use Microdata Sample; Texas State Data Center; and Texas Health
and Human Services Commission.”
Note: Sums may not add up exactly to total due to rounding..
2016 Texas Non-Older Disabled Population *
by Region and Poverty Status
Region
Total A&D Population
Percent of
State Total A&D Population Below Poverty
Percent of
State Total
1 Lubbock
72,0003.5% 17,0003.2%
2/9 Abilene
116,0005.6% 23,0004.4%
3 Grand Prairie
472,000
4 Tyler
117,0005.7% 32,0006.0%
5 Beaumont
22.8%
114,000
21.8%
92,0004.4% 23,0004.4%
6 Houston
429,00020.7% 102,00019.5%
7 Austin
233,00011.3% 53,00010.1%
8 San Antonio
260,000
12.6%
67,000
12.8%
81,000
3.9%
23,000
4.4%
192,000
9.3%
67,000
12.8%
10 El Paso
11 Edinburg
State Total
2,069,000100% 525,000100%
*The disabled population includes people under 65 with one or more limitations in a functional activity or a social role.
Data Sources: Census Bureau, 2014 American Community Survey (ACS), Public Use Microdata Sample; Texas State Data Center; and
Texas Health and Human Services Commission.
Note: Sums may not add up exactly to total due to rounding.
93
Poverty Income Guidelines for the Continental United States • Actual
by Year
2012
2013 2014
2015
1
$11,170 $11,490 $11,670 $11,770
2
$15,130 $15,510 $15,730 $15,930
3
$19,090 $19,530 $19,790 $20,090
4
$23,050 $23,550 $23,850 $24,250
5
$27,010 $27,570 $27,910 $28,410
6
$30,970 $31,590 $31,970 $32,570
7
$34,930 $35,610 $36,030 $36,730
8
$38,890 $39,630 $40,090 $40,890
DADS
l
Family Size
Note - For each additional family member add $3,960 for 2012, $4,020 for 2013, $4,060 for 2014 and $4,160 for 2015.
Data Source: U.S. Department of Human Services. Office of the Assistant Secretary for Planning and Evaluation (ASPE).
Median Income for Texas • Estimated
by Federal Fiscal Year
Family Size
2013
2014
2015
2016
1
$34,368 $34,778
$35,234
$36,149
2
$44,943 $45,478
$46,075
$47,272
3
$55,518 $56,179
$56,916
$58,394
4
$66,093 $66,880
$67,757
$69,517
5
$76,668 $77,581
$78,598
$80,640
6
$87,243 $88,282
$89,439
$91,762
Note - For each additional household member above six persons, add 3 percentage points to the percentage for a six-person household (132 percent), and multiply the new
percentage by the Stateís estimated median income for a four-person household.
Source: U.S. Department of Health and Human Services, Administration for Children and Families
Per Capita Personal Income • Estimated/Projected
by Year
Geographic Area
2013 Estimated
2014 Estimated
2015 Projected
Texas
$43,807 $45,669$46,893$48,377
U.S.
$44,438 $46,049
$47,585
Data Sources: U.S. Department of Commerce - Bureau of Economic Analysis (BEA), and IHS Global Insight’s Economic Forecast for Texas and the U.S.
94
2016 Projected
$49,369
Section III
l
Labor Force Statistics for Texas and the U.S.
by Federal Fiscal Year
FFY Year
Civilian Labor Force
Number of Unemployed
Unemployment Rate
Texas
2013
12,905,000
801,0006.20%
2014
13,112,000
664,0005.10%
2015 (Projected)
13,101,300
552,812
4.22%
2016 (Projected)
13,227,020
571,272
4.32%
U.S.
2013
155,389,000 11,460,0007.40%
2014
155,922,000 9,617,0006.20%
2015 (Projected)
155,899,000
9,558,000
6.15%
2016 (Projected)
157,539,000
8,473,000
5.38%
Civilian Labor Force
Number of Unemployed
Unemployment Rate
4,425,271
17,159
4.0
568,224
22,204
3.9
3,713,810
184,444
5.0
4 Tyler
511,166
27,885
5.5
5 Beaumont
332,253
23,547
7.1
6 Houston
3,330,736
163,456
4.9
7 Austin
1,617,709
72,006
4.5
8 San Antonio
1,318,189
61,891
4.7
10 El Paso
358,989
23,404
6.5
11 Edinburg
935,224
68,004
7.3
13,111,571
664,000
5.1
Data Sources: Texas Workforce Commission; IHS Global Insight and Texas Health and Human Services Commission.
Labor Force Statistics for Texas • Calendar Year 2014
by HHS Region
Calendar Year
1 Lubbock
2/9 Abilene
3 Grand Prairie
State Total
Data Source: Texas Workforce Commission.
95
State Rankings
(based on the most current information available)
l
n
In 2014, Texas had the second largest population among the states and DC (27.2 million). The only
state with a larger population was California, with a population of 38.8 million.
DADS
Data Source: U.S. Census Bureau, American Factfinder. Annual Estimates of the Population for the Resident Population: April 1, 2010 to July 1, 2014. 2014 Population
Estimates.
n
In 2014, Texas had the fourteenth highest rate of poverty among the states (including DC), with a rate
of 17.2 percent. Mississippi had the highest rate (21.5 percent), and New Hampshire had the lowest
(9.2 percent). The U.S. poverty rate was 15.5 percent.
Data Source: U.S. Census Bureau. 2014 American Community Survey.
n
During 2014, Texas ranked 24th among the states (including DC) with a median household income
of $53,035. Maryland had the highest median household income ($73,971), and Mississippi had the
lowest ($39,680). The figure for the U.S. was $53,657.
Data Source: U.S. Census Bureau. 2014 American Community Survey.
n
In 2014, Texas ranked 23rd among the states (including DC) with a per capita personal income
of $45,669. The District of Columbia had the highest per capita personal income ($69,838), and
Mississippi had the lowest ($34,431). The U.S. per capita personal income was $46,049.
Data Source: U.S. Department of Commerce, Bureau of Economic Analysis.
n
In September 2015, Texas had the 13th lowest unemployment rate among the states (including DC),
with a seasonally adjusted unemployment rate of 4.2 percent. West Virginia had the highest rate (7.3
percent), and North Dakota had the lowest (2.8 percent). The U.S. unemployment rate stood at 5.1
percent.
Data Source: U.S. Bureau of Labor Statistics.
n
In federal fiscal year 2013, Texas ranked 44th among the states (excluding DC) in terms of per capita
welfare expenditures ($1,161). New York spent the most ($2,945) and Nevada the least ($860). The
figure for the U.S. as a whole was $1,640.
Data Source: U.S. Census Bureau.
n
In 2014, Texas ranked first among the states (including DC), with the highest percentage of the
population not covered by health insurance, with 19.1 percent of its population uninsured. The state
with the second highest percentage of uninsured was Alaska (17.2 percent), and Massachusetts had
the lowest percentage (3.3 percent). The uninsured rate in the U.S. in 2013 was 11.7 percent.
Data Source: U.S. Census Bureau.
n
In federal fiscal year 2014, the five states with the highest Medicaid expenditures were California
($63,941,985,764), New York ($54,204,075,597), Texas ($32,202,713,428), Pennsylvania
($23,622,494,930) and Florida ($20,425,755,781).
Data Source: Henry J. Kaiser Family Foundation.
96
Section IV.
Appendices
97
97
Volunteer and Community Engagement
DADS
l
The Volunteer and Community Engagement (VCE) unit creates and supports DADS volunteer
programs, community involvement efforts and public/private partnerships. Some programs require
prospective volunteers to submit an application or to complete additional training and undergo
background checks.
DADS Volunteer Opportunities
Long-term care facilities offer volunteer opportunities that benefit the residents of nursing facilities and
assisted living facilities. For more information, call 800-889-8595 or visit www.volunteeratdads.org.
Community Services regional offices provide services and supports to Texans who are older and people
with disabilities. Services include home-delivered meals, emergency response services, attendant care,
home modifications and medical supplies. Volunteer opportunities are available in each regional office.
Most opportunities involve positions that provide administrative support.
For more information, call 800-889-8595 or visit www.volunteeratdads.org.
State supported living centers help support and improve the quality of life for individuals with intellectual
and/or developmental disabilities who receive 24-hour care in these residential facilities.
All living centers have comprehensive volunteer programs that provide a variety of opportunities
and activities designed to enhance residents’ quality of life, such as:
l
Assistance with observance of holiday ceremonies
l
Art classes
l
Music therapy
l
Recreational activities
Funds are raised to purchase equipment (such as electric wheelchairs or wheelchair accessible vans)
for residents or to renovate buildings for worship services, homes for family visitations and gyms for
athletic events. Financial and in-kind donations are always welcomed. For more information,
call 800-889-8595.
Texas Benefits Counseling Program volunteers to provide information, counseling, assistance and advocacy
for older adults and others who are Medicare-eligible regarding their benefits, entitlements and legal
rights. If you are interested in becoming a volunteer benefits counselor, contact your local area agency
on aging (AAA) at 800-252-9240 to discuss how you can serve others in your community.
DADS Community Engagement Opportunities
Texercise, a statewide health promotions program, educates and involves people and communities in
physical activity and proper nutrition. The Texercise program promotes policies and activities that
support fitness in all areas of life, including individual activities, community events, environmental
changes and worksite wellness initiatives.
98
Section IV
l
For more information, call 800-889-8595 or
visit www.Texercise.com.
Appendices
Public/private partnerships help promote
statewide opportunities for volunteerism
and build collaborations that create public
awareness for DADS programs. Texans benefit
from increased resources, connections and
services through the generous contributions
of partners.
For more information, call 800-889-8595.
Age Well Live Well (AWLW) is a collaborative
community initiative that enhances the quality
of life for older Texans and people with disabilities by:
l
Providing health and wellness programs and policies.
l
Creating volunteer and community engagement opportunities.
l
Sharing information on the services and programs available.
Through Age Well Live Well, local and state organizations develop a community partnership to provide
area residents with information and opportunities on local, state and federal programs. The programs
highlighted in AWLW initiatives are easily implemented in community settings, and most are free or
have minimal costs. The initiatives are developed at the local level, with support from statewide partners.
For more information, call 800-889-8595.
99
Interest Lists
DADS
l
Because the demand for DADS community-based services and supports often outweighs available
resources, names are placed on interest lists until services are available. However, some needs may be
met through other programs or services until funding becomes available.
The names of interested parties are placed on interest lists on a first-come, first-served basis. When a
name comes to the top of the list, the person will be contacted by DADS staff or a contracted provider.
When eligibility is confirmed, the person chooses a provider agency or uses the consumer directed
services (CDS) option and, in certain areas of the state, the service responsibility option (SRO).
Interest lists for community-based programs are managed either locally or statewide, depending on the
program. The following waiver programs have interest lists:
l
l
l
l
ome and Community-Based Services (HCBS) STAR+PLUS Waiver (operated by the Texas Health
H
and Human Services Commission)
l
l
Texas Home Living (TxHmL)
These Title XX programs also have interest lists:
l
Adult Foster Care
l
Consumer Managed Personal Attendant Services
l
l
l
Family Care
l
Home-delivered meals
l
Residential Care
l
Special Services for Persons with Disabilities
There is also an interest list for the general revenue-funded In-Home and Family Support Program.
Allocations are based on available funding. People whose names have been on the interest lists the
longest are released first unless they are a member of a specified target group. Enrollment is handled
by DADS regional case managers, local intellectual and developmental disability authorities, CLASS
providers and DBMD providers.
More information about DADS Interest lists can be found at www.dads.state.tx.us/services/
interestlist/index.html#ftnt3
100
Section IV
l
Interest List (IL) Releases • Summary
Appendices
FY 2014 – Oct. 31, 2015 CLASSDBMD
Current IL counts (as of Oct. 31, 2015)
Enrolled
53,698
209
HCSMDCP TxHmLTotal
72,877
19,052
50,599
196,435
11 2435
138283
869
Denied/declined/withdrawn
39039192
775278
1,674
In the Pipeline
945
209
1,313
2,551
1,332
6,350
1,345
251
1,940
3,468
1,893
8,897
235
34
200
269
174
912
54,083
221
73,011
20,540
50,683
198,538
Total releases this biennium (since Sept. 1, 2015)
New requests added this biennium
Previous biennium counts (as of Aug. 31, 2015)
1.HCS and TxHmL counts for Released/Removed and Total Releases are derived from CARE data source, not CSIL, and provided by Local Authority staff.
2.Released/Removed counts include individuals already in the pipeline as of August 31, 2015, excluding MFP.
3. An individual may be counted more than once in the Enrolled and Denied/Declined/Withdrawn categories, but only once in Total Releases.
Therefore, Release/Removal counts may be higher than the total count of released individuals.
4. Totals unique individuals with close codes in this category, who also had a release date (except HCS and TxHmL, see note 1).
5. The total of Current Interest List Counts in the above table is a duplicated count. The unduplicated count across all four Interest Lists is: 101,821.
Time on DADS Interest Lists • Percentage by Waiver
As of October 2015
Time on Interest List CLASS
Percent Distribution by Waiver
DBMD*
HCS
MDCP
TxHmL
0-1 years
8.0%
97.6%
8.7%
23.2%
11.5%
1-2 years
9.0%
2.4%
9.9%
24.0%
14.2%
2-3 years 9.5%
0.0%
10.4
23.7%
15.0%
3-4 years 10.0%
0.0%
11.5%
24.1%
16.3%
4-5 years
12.0%
0.0%
11.6%
5.1%
16.1%
5-6 years 12.8%
0.0%
12.0%
0.0%
16.3%
6-7 years
11.3%
0.0%
10.6%
0.0%
10.4%
7-8 Years
10.2%
0.0%
8.5%
0.0%
0.1%
8-9 years
8.7% 0.0%
7.1%
0.0%
0.0%
9-10 years
5.9%
0.0%
5.6%
0.0%
0.0%
10-11 years
0.0%
0.0%
0.0%
0.0%
0.0%
11-12 years
0.0%
0.0%
0.0%
0.0%
0.0%
Totals
100%100% 100%100%100%
* Some people on the DBMD interest list have reached the top of the list several times and declined services, yet chose to remain on the list.
101
Time on DADS Interest Lists • Count by Waiver
DADS
l
As of October 2015
Time on Interest List
CLASS
0-1 years 4,298
204
6,348
4,414
5,835
1-2 Years
4,851
5
7,227
4,564
7,200
2-3 years
5,124 N/A
7,593
4,519
7,580
3-4 years
5,582
N/A
8,368
4,587
8,226
4-5 years
6,463
N/A
8,431 968
8,150
5-6 years
6,860
N/A
8,757
N/A
8,269
6-7 years
6,042
N/A
7,737
N/A
5,264
7-8 years
5,476
N/A
6,186
N/A
61
8-9 years
4,647
N/A
5,193
N/A
7
9-10 years
3,170
N/A
4,111
N/A
3
10-11 years
1,184
N/A
2,916
N/A
3
11-12 years
1
N/A
5
N/A
1
12-13 years
N/A
N/A
3
N/A
N/A
13-14 years
N/A
N/A
2
N/A
N/A
Totals
53,698
Average Number of People by Waiver
DBMD*
HCS
MDCP
209 72,877 19,05250,599
* Some people on the DBMD interest list have reached the top of the list several times and declined services, yet chose to remain on the list.
More information about DADS interest lists can be found at www.dads.state.tx.us/services/interestlist/index.html#ftnt3
102
TxHmL
Section IV
l
Functional Needs Assessment Process
Appendices
Functional need is defined as a requirement for assistance with activities of daily living caused by
a physical or mental limitation or disability. An assessment must be performed for most applicants
of community services programs before functional need can be determined. The Form 2060, Needs
Assessment Questionnaire and Task/Hour Guide, is the instrument used to make this determination.
This questionnaire determines the applicant’s functional needs and ability to carry out activities of daily
living. Careful assessment yields information on what the applicant can do for himself, what he should
continue to do for himself to maintain his current level of self-sufficiency, and what he cannot do for
himself because of physical or mental limitations, or both.
An applicant’s functional level is based on:
l
Physical condition.
l
Medical problems and the limitations they impose.
l
Mental clarity and limitations and the effect they have on performing activities of daily living.
l
The condition of the home environment.
An applicant’s functional capacity should always be assessed in relation to the home environment in
which the tasks are performed. The age of the person being assessed for services must not be considered
when determining the level of functional need.
The applicant’s functional capabilities are evaluated on tasks such as bathing, dressing, exercising,
feeding, grooming, toileting, mobility (including walking and transferring from bed to chair),
housekeeping and cleaning, laundry, meal preparation and the need for escort. The need for assistance
with activities such as shopping, assistance with medications and telephone usage is also taken
into account.
The case manager conducting the assessment must decide which of four impairment levels best fits the
applicant being assessed:
l
l
l
l
0 = No impairment. The applicant is able to conduct activities without difficulty
and has no need for assistance.
1 = Minimal/mild impairment. The applicant is able to conduct activities with
minimal difficulty and needs minimal assistance.
2 = Extensive/severe impairment. The applicant has extensive difficulty carrying
out activities and needs extensive assistance.
3 = Total impairment. The applicant is completely unable to carry out any
part of the activity.
The case manager scores each item on the questionnaire and then computes the total score to determine
whether the applicant is eligible for services.
Note: A functional needs assessment is not completed for applicants for an IDD program. The local
intellectual and developmental disability authority conducts or endorses a determination of intellectual
disability (DID) for them.
103
Medical Necessity Determination Process
DADS
l
Medical necessity (MN) is a prerequisite for participation in some
Medicaid Title XIX long-term services and supports programs.
To verify that medical necessity exists, an applicant must meet
the conditions described in at least one of the following general
qualifications:
l
ust demonstrate a medical disorder or disease or both with a
M
related impairment that limits the ability to recognize problems,
changes in the applicant’s condition, and the need for or side
effects of prescribed medications; is of sufficient seriousness that
the needs exceed the routine care that may be given by an untrained
person; and requires nurses’ supervision, assessment, planning
and intervention.
OR
l
e applicant must require medical/nursing services that are ordered by and remain under the
Th
supervision of a physician; are dependent upon the individual’s documented medical, physical, and/or
functional disorders, conditions or impairments; require the skills of registered or licensed vocational
nurses; are provided either directly by or under the supervision of licensed nurses in an institutional
setting; and are required on a regular basis.
Specific criteria are used to determine if an applicant requires medical care in a nursing facility. Services
that may qualify someone for MN determination include:
l
l
Administration of intramuscular medications and observation of the person’s response and side effects.
l
Administration and adjustment of medication for pain, and monitoring of result and side effects.
l
104
outine monitoring of the person to determine responses to the treatment plan and to detect problems
R
requiring the physician’s attention and/or a change in the plan of care.
ehabilitative/restorative care, passive range-of-motion (ROM) exercises and positioning, care and
R
assistance for application of braces/prosthetic devices or reinforcement of maintenance rehabilitative
procedures.
Section IV
Appendices
Description
l
Toll-free Hotline Numbers
Hotline Number
Area agencies on aging (AAAs)
800-252-9240
AARP Elder Care Locator
800-677-1116
Texas Department of Family and Protective Services (DFPS) Abuse/Neglect Reports in community settings
800-252-5400
Alzheimer’s Association
800-272-3900
Aging and disability resource centers (ADRCs)
855-937-2372
Consumer Rights and Services (all complaints and information regarding DADS programs
and services, complaints regarding assisted living facilities and nursing home facilities, etc.)
800-458-9858
Texas Department of State Health Services Consumer Rights
800-252-8154
Emergency dental, rehab/specialized services
800-792-1109
Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps)
– Complaints
– Inquiry
800-252-9330
800-448-3927
Governor’s Helpline
800-843-5789
HHSC Office of Ombudsman Customer Assistance
888-834-7406
HHSC Medicaid/Managed Care Helpline
866-566-8989
Interest List Hotline
877-438-5658
Legal Hotline for Older Texans
800-622-2520
Long-term Care Facility Incident Reporting
800-458-9858
Long-term Care Ombudsman Program
800-252-2412
Long-term Care Credentialing (Employee Misconduct Registry,
Nurse Aide Registry, and Medication Aide Program)
800-452-3934
Medicaid
– Eligibility requirements
– General (for claims, services, and providers)
– Medically needy
800-834-7106
800-252-8263
800-335-8957
Medicare
– Provider contact center Part A – Provider contact center Part B
– Provider contact center (hearing impaired)
– Beneficiary contact center
866-640-9202
866-280-6520
866-566-9163
800-633-4227
Social Security Benefit Applications and Benefit Information
800-772-1213
Texas Attorney General’s Consumer Helpline
800-621-0508
Volunteer and Community Engagement
800-889-8595
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DADS Headquarters Directory
Location:
John H. Winters Human Services Complex
Street Address:
701 W. 51st St. Austin, Texas 78751-2312
Mailing Address:
P.O. Box 149030 Austin, Texas 78714-9030
Phone: 512-438-3011
Fax:512-438-4747
DADS Council Members
Name
Term Expiration Date
John A. Cuellar, chair
02/01/2017
Judy Foster, vice chair
02/01/2017
Glyn S. Crane 02/01/2019
Ann Schneider 02/01/2019
Donna Stauber 02/01/2015
Sheri Harmonson 02/01/2015
Barry L. Anderson 02/01/2015
Edward E. Yosowitz 02/01/2017
DADS Executive Team
Position/Title
Commissioner
Jon Weizenbaum
512-438-3030
Deputy Commissioner
Kristi D. Jordan
512-438-3030
Chief Financial Officer David Cook 512-438-3355
Chief Operating Officer
Lynn W. Blackmore
512-438-3030
Elisa J. Garza
512-438-4245
Mary T. Henderson
512-438-2625
Scott Schalchlin
512-438-3076
Lawrence Hornsby
512-438-3154
Penny Rychetsky
512-438-5638
Allison Lowery
512-438-4404
Michelle Martin
512-438-4646
Heather Hall
512-438-4985
Assistant Commissioner, A & I
Assistant Commissioner, Regulatory Services
Assistant Commissioner, State Supported Living General Counsel
Director, Internal Audit
Director, Center for Consumer and External Affairs
Director, Center for Policy and Innovation
Manager, Information Resources
106
NamePhone
Section IV
l
Contacts
Appendices
The following list of state office contacts is provided for those individuals seeking
additional information.
DADS State Office Contacts
Area of Interest
Contact Person
Access & Intake Varied Staff
Phone
512-438-5724
AccountingVacant
Adult Day Care Licensing
Annie Aguirre
512-438-2348
Aging and Disability Resource Centers Wes Yeager 512-438-4296
Area Agencies on Aging (AAAs)
Sue Fielder
512-438-4238
Assisted Living Facility LicensingLicensing
Bill Fordyce
512-438-3544
Budget and Data Management
Vacant
Center for Consumer and External Affairs
Allison Lowery
512-438-4404
Center for Policy and Innovation
Michelle Martin
512-438-4646
Claims Management
Vacant
512-438-4909
CNA licensing/renewals/Nurse Aide Registry/Medical Aide Training
Rebeca Botbyl
512-438-2016
Communications Director
Jeff Peck
512-438-2879
Community Access & Grants
Wes Yeager 512-438-4296
Community Services Contracts
Bill Campbell
512-438-5175
Consumer Rights and Services
Shareen Addison
800-458-9858
Contract Oversight and Support
Kathie Carleton-Morales
512-438-5046
Executive and Staff Operations
Glen Bason
512-438-5744
Elizabeth Yocum
512-438-4088
Government Relations
Cynthia Nottingham
512-438-3654
Grant Monitoring and Support
Leigh Schroeder
512-438-3383
Guardianship
Tim McGinnis
512-438-4727
Home Health/Hospice
Sylvia Rodriguez
512-438-2183
Intermediate Care Facilities
Vacant
512-438-3544
Information Technology
Jody Ashlock (interim) 512-438-4985
Legal Services
Lawrence Hornsby 512-438-3154
Local intellectual and developmental disability authorities
Anthony Jalomo
512-438-3528
Media Relations
Cecilia Cavuto
512-438-4404
Medicaid Estate Recovery Program
Nicole Hawk
512-438-4718
Nursing Facility Licensing
Annie Aquirre
512-438-2348
Independent Ombudsman
George Bithos
512-438-4050
Continued on next page
107
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DADS State Office Contacts (continued)
108
Area of Interest
Contact Person
Phone
Pre-admission Screening and Resident Review
Geri Willems
512-438-3159
Program Business Operations
Nicole Hawk
512-438-4718
Promoting Independence Initiative
Vacant
512-438-2260
Quality Reporting
Curtis Walters
512-438-2116
Quality Monitoring Program
Michelle Dionne-Vahalik
512-438-2116
Regulatory Services Enforcement
Vacant
512-438-3099
Regulatory Services ICFs Contracts
Vacant
512-438-3544
Regulatory Services NF Contracts
Annie Aguirre
512-438-2348
Regulatory Services Licensing and Credentialing
Cindy Bourland
512-438-3097
Regulatory Services Policy, Rules & Curriculum Development
Calvin Green
512-438-3603
Regulatory Services Survey Operations
Linda Lothringer 512-438-5695
SSLC Settlement Agreement Compliance
Becky McPherson 512-438-3806
Scott Schalchlin
512-438-3076
State Supported Living Centers Operations
Vacant
512-438-5584
Strategic Operations and Grants
Wes Yeager
512-438-4296
Texas Long-term Care Ombudsman
Patty Ducayet
512-438-4356
Utilization Management and Review
Cindy Kenneally
512-438-4151
Volunteer & Community Engagement
Holly Riley
512-438-2255
Waiver and State Plan Services
-
512-438-2116
Section IV
l
Area Agencies on Aging
Sherman Hansford Ochiltree Lipscomb
Hartley
Moore
Oldham
Potter
Armstrong
Randall
Castro
Swisher
Hemphill
Gray
Wheeler
Donley
Collingsworth
Carson
20
Deaf Smith
Parmer
Hutchinson Roberts
Briscoe
Appendices
Dallam
Location
by County and
AAA Catchment Area
Childress
Hall
Hardeman
Hockley
Lubbock
Yoakum
Terry
Lynn
Dawson
Andrews
El Paso
Loving
Hudspeth
Culberson
Winkler
Ward
Ector
Crane
Reeves
Motley
Cottle
Crosby
Dickens
King
24
Gaines
22
Floyd
Martin
Borden
Howard
Scurry
Midland Glasscock Sterling
21
Upton
Reagan
Irion
Pecos
Jeff Davis
Fisher
Mitchell
Knox
Stonewall Haskell
Kent
Garza
19Wichita
Wilbarger
Foard
Nolan
Coke
Jones
28
Runnels
Tom
Green
8
Throckmorton
Schleicher
Menard
Sutton
Kimble
Brewster
Erath
Brown
McCulloch
Real
Kinney
Uvalde
14
Bell
Llano
5
1
3
1 • Area Agency on Aging of the Alamo Area
2 • Area Agency on Aging of Ark-Tex
3 • Area Agency on Aging of Bexar County
4 • Area Agency on Aging of Brazos Valley
5 • Area Agency on Aging of the Capital Area
6 • Area Agency on Aging of Central Texas
7 • Area Agency on Aging of the Coastal Bend
8 • Area Agency on Aging of Concho Valley
9 • Area Agency on Aging of Dallas County
10 • A rea Agency on Aging of Deep East Texas
11 • A rea Agency on Aging of East Texas
12 • A rea Agency on Aging of the Golden Crescent Region
13 • A rea Agency on Aging of Harris County
14 • A rea Agency on Aging of the Heart of Texas
15 • A rea Agency on Aging of Houston-Galveston
16 • A rea Agency on Aging of the Lower Rio Grande Valley
17 • A rea Agency on Aging of the Middle Rio Grande
18 • A rea Agency on Aging of North Central Texas
19 • A rea Agency on Aging of North Texas
Zavala
17Dimmit
Frio
McMullen
Duval
Live Oak
Jim
Wells
Zapata
Jim Hogg
Brooks
Starr
Hidalgo
16
Walker
4 Grimes
Austin
Lavaca
Jackson
Bee
San
Jacinto
10 Jasper
Tyler
Hardin
Liberty
Harris13
15
Fort Bend
Wharton
12
Polk
Montgomery
Waller
San
Augustine Sabine
Angelina
Trinity
Madison
Washington
Victoria
23Orange
Jefferson
Chambers
Galveston
Brazoria
Matagorda
Calhoun
Refugio
Aransas
Nueces
Kleberg
25
Shelby
Houston
Brazos
Guadalupe
Karnes
Panola
Nacogdoches
Leon
Colorado
Gonzales
Rusk
Harrison
Cherokee
Falls
Fayette
Wilson
Cass
Marion
Gregg
11
2
Anderson
Bastrop
San Patricio
Webb
Smith
Henderson
Burleson
Goliad
La Salle
Van
Zandt
Robertson
Caldwell
Atascosa
Titus
Camp
Wood Upshur
Rains
Kaufman
Milam
De Witt
Maverick
Hopkins
Limestone
Lee
Hays
Medina
6
Travis
Comal
Bexar
Bowie
Navarro
Williamson
Kendall
Bandera
Red River
Delta
Freestone
Coryell
Blanco
Lamar
Ellis
McLennan
Lampasas
San Saba
Kerr
Edwards
Hunt
Hill
Bosque
Hamilton
Gillespie
Val Verde
Johnson
Burnet
Terrell
Presidio
Collin
Somervell
Mason
Crockett
Fannin
Tarrant
26
18Dallas
Hood
Mills
Concho
27
9Rockwall
Parker
Comanche
Coleman
Grayson
Wise
Palo
Pinto
Eastland
Callahan
Cooke
Denton
Jack
Young
Stephens
Shackleford
Taylor
Clay Montague
Archer
Baylor
Newton
Hale
Morris
Cochran
Lamb
Franklin
Bailey
7
Kenedy
Willacy
Cameron
20 • A rea Agency on Aging of the Panhandle
21 • A rea Agency on Aging of the Permian Basin
22 • Area Agency on Aging of the Rio Grande Area
23 • Area Agency on Aging of Southeast Texass
24 • A rea Agency on Aging of South Plains
25 • Area Agency on Aging of South Texas
26 • A rea Agency on Aging of Tarrant County
27 • A rea Agency on Aging of Texoma
28 • A rea Agency on Aging of West Central Texas
Data sources: AAA data as of October 2012
Note: AAA of Bexar County and AAA of the Alamo Area are so close together that their icons overlap on the map. They are separate AAAs.
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Rose Ryan • director210-362-5561
8700 Tesoro, Suite 700
886-231-4922
San Antonio, Texas 78217
Serves Atascosa, Bandera, Comal, Frio, Gillespie, Guadalupe, Karnes, Kendall, Kerr, Medina,
McMullen and Wilson counties.
Area Agency on Aging of Ark-Tex
Diane McKinnon • manager903-832-8636
P.O. Box 5307
800-372-4464
Texarkana, Texas 75505-5307
Serves Bowie, Cass, Delta, Franklin, Hopkins, Lamar, Morris, Red River and Titus counties.
Rose Ryan • director210-362-5254
8700 Tesoro, Suite 700
800-960-5201
Serves Bexar County.
Ronnie Gipson • director979-595-2806
3991 E. 29th St.
800-994-4000
Bryan, Texas 77802-4228
Serves Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington counties.
Jennifer Scott • director512-916-6062
6800 Burleson Road, Bldg. 310, Suite 165
888-622-9111
Austin, Texas 78744-2306
Serves Bastrop, Burnet, Blanco, Caldwell, Fayette, Hays, Lee, Llano, Travis and Williamson counties.
H. Richard McGhee • director254-770-2330
2180 N. Main St.
800-447-7169
Belton, Texas 76513-1919
Serves Bell, Coryell, Hamilton, Lampasas, Milam, Mills and San Saba counties.
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l
Appendices
Betty Lamb • director361-883-3935
2910 Leopard
800-817-5743
Corpus Christi, Texas 78408-3614
Serves Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak, Nueces, Refugio
and San Patricio counties.
Toni Gutierrez • director325-223-5704
2801 W. Loop 306, Suite A
877-944-9666
San Angelo, Texas 76904
Serves Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan, Schleicher,
Sterling, Sutton and Tom Green counties.
Marilyn Self • director214-871-5065
1349 Empire Central, Suite 400
800-548-1873
Dallas, Texas 75247-4033
Serves Dallas County.
Holly Anderson • director409-384-7614
210 Premier Drive 800-435-3377
Jasper, Texas 75951-7495
Serves Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San Augustine, San Jacinto, Shelby,
Trinity and Tyler counties.
Bettye Mitchell • director903-918-6500
3800 Stone Road
800-442-8845
Kilgore, Texas 75662-6927
Serves Anderson, Camp, Cherokee, Gregg, Harrison, Henderson, Marion, Panola, Rains, Rusk, Smith,
Upshur, Van Zandt and Wood counties.
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Cindy Cornish • director361-578-1587
120 S. Main St., Suite 120
800-574-9745
Victoria, Texas 77901
Serves Calhoun, DeWitt, Goliad, Gonzales, Jackson, Lavaca and Victoria counties.
Deborah A. Moore • director832-393-4301
8000 N. Stadium Drive, 3rd Floor
800-213-8471
Houston, Texas 77054
Serves Harris County.
Gary W. Luft • director254-292-1800
1514 S. New Road
866-772-9600
Waco, Texas 76711-1316
Serves Bosque, Falls, Freestone, Hill, Limestone and McLennan counties.
Area Agency on Aging of Houston-Galveston
Curtis M. Cooper • manager713-627-3200
3555 Timmons Lane, Ste. 120
800-437-7396
Houston, Texas 77027-6468
Serves Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Liberty, Matagorda,
Montgomery, Walker, Waller and Wharton counties.
Jose L. Gonzalez • director956-682-3481
301 W. Railroad St.
800-365-6131
Weslcao, Texas 78596
Serves Cameron, Hidalgo and Willacy counties.
Area Agency on Aging of the Middle Rio Grande
Elda Garcia • director830-876-3533
307 W. Nopal St.
800-224-4262
Carrizo Springs, Texas 78834-3211
Serves Dimmit, Edwards, Kinney, LaSalle, Maverick, Real, Uvalde, Val Verde and Zavala counties.
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Section IV
l
Appendices
Doni Green • manager817-695-9194
616 Six Flags Drive, Ste. 200
800-272-3921
Arlington, Texas 76011-6317
Serves Collin, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker,
Rockwall, Somervell and Wise counties.
Rhonda K. Pogue • director940-322-5281
4309 Jacksboro Highway, Ste. 2
800-460-2226
Wichita Falls, Texas 76302-2740
Serves Archer, Baylor, Clay, Cottle, Foard, Hardeman, Jack, Montague, Wichita, Wilbarger
and Young counties.
Area Agency on Aging of the Panhandle
Melissa Carter • director806-331-2227
415 SW 8th Ave.
800-642-6008
Amarillo, Texas 79101-2215
Serves Armstrong, Briscoe, Carson, Castro, Childress, Collingsworth, Dallam, Deaf Smith, Donley, Gray,
Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Parmer,
Potter, Randall, Roberts, Sherman, Swisher and Wheeler counties.
Jeannie Reeves • director432-563-1061
2910 Laforce Blvd.
800-491-4636
Midland, Texas 79711-0660
Serves Andrews, Borden, Crane, Dawson, Ector, Gaines, Glasscock, Howard, Loving, Martin, Midland,
Pecos, Reeves, Terrell, Upton, Ward and Winkler counties.
Yvette Lugo • director915-533-0998
8037 Lockheed, Suite 100
800-333-7082
El Paso, Texas 79902-2400
Serves Brewster, Culberson, El Paso, Hudspeth, Jeff Davis and Presidio counties
113
l
Colleen Halliburton • director409-924-3381
2210 Eastex Freeway
800-395-5465
Beaumont, Texas 77703-4929
DADS
Serves Hardin, Jefferson and Orange counties.
Liz Castro • director806-687-0940
1323 58th St.
888-418-6564
Lubbock, Texas 79412
Serves Bailey, Cochran, Crosby, Dickens, Floyd, Garza, Hale, Hockley, King, Lamb, Lubbock, Lynn,
Motley, Terry and Yoakum counties.
Alberto Rivera Jr. • Aging Services director956-722-3995
1002 Dicky Lane
800-292-5426
Laredo, Texas 78043-4237
Serves Jim Hogg, Starr, Webb and Zapata counties.
Don Smith • director817-258-8081
1500 N. Main St., Suite 200
877-886-4833
Fort Worth, Texas 76164-0448
Serves Tarrant County.
Dr. Randy McBroom • director903-813-3505
1117 Gallagher Drive, Suite 200
800-677-8264
Sherman, Texas 75090-1797
Serves Cooke, Fannin and Grayson counties.
Michelle Parker • director325-672-8544
3702 Loop 322
800-928-2262
Abilene, Texas 79602-7300
Serves Brown, Callahan, Coleman, Comanche, Eastland, Fisher, Haskell, Jones, Kent, Knox, Mitchell, Nolan,
Runnels, Scurry, Shackelford, Stephens, Stonewall, Taylor and Throckmorton counties.
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Section IV
Hartley
Moore
Oldham
Potter
Carson
Randall
Armstrong
16
Deaf Smith
Castro
Parmer
Hutchinson Roberts
Swisher
Appendices
Dallam
l
Aging and Disability Resource Centers (ARDC)
Hemphill
Gray
Wheeler
Location
Donley
Collingsworth
by Counties Served
Briscoe
Childress
Hall
Hardeman
Cochran
Hockley
Lubbock
Yoakum
Terry
Lynn
Dawson
Andrews
El Paso
Loving
Hudspeth
Culberson
Winkler
Ward
Ector
Crane
Reeves
Motley
Cottle
Crosby
Dickens
King
18
Gaines
2
Floyd
Martin
Borden
Howard
Scurry
22
Upton
Reagan
Irion
Pecos
Jeff Davis
Fisher
Mitchell
Knox
Stonewall Haskell
Kent
Garza
Wilbarger
Foard
Nolan
Coke
Tom
Green
11
Jones
21
Runnels
Throckmorton
Palo
Pinto
Erath
Eastland
Schleicher
Menard
Sutton
Kimble
Brown
McCulloch
Kinney
Uvalde
Johnson
Bosque
14
Llano
Kendall
Medina
7
4
Frio
1
Dimmit
McMullen
Lavaca
Bee
1 • ADRC of the Capital Area
2 • Aging, Disability and Transportation Resource Center
of El Paso and Far West Texas
3 • ADRC of Texoma
4 • Alamo Service Connection ADRC
5 • Brazos Valley ADRC
6 • Care Connection ADRC
7 • Central Texas Aging and Disability Resource Center
8 • Coastal Bend ADRC
9 • South Texas ADRC
10 • Connect to Care
11 • Concho Valley ADRC
12 • East Texas ADRC
13 • Golden Crescent Aging and Disability Resource Center
14 • Heart of Texas ADRC
15 • North Central Texas ADRC
Webb
Duval
Zapata
Jim Hogg
Brooks
Starr
Hidalgo
17
Jackson
San
Jacinto
6
Fort Bend
19 Jasper
Tyler
Hardin
Liberty
Orange
Jefferson
Chambers
Galveston
Brazoria
Matagorda
Calhoun
Refugio
Aransas
Nueces
Kleberg
9
Harris
Wharton
13
Polk
Montgomery
Austin Waller
Victoria
San Patricio
Jim
Wells
5 Grimes
Colorado
Guadalupe
Live Oak
Walker
San
Augustine Sabine
Angelina
Trinity
Madison
Washington
Fayette
Goliad
La Salle
Shelby
Houston
Brazos
Bastrop
Karnes
Panola
Nacogdoches
Leon
Falls
Lee
Gonzales
Rusk
Harrison
Anderson
Limestone
Burleson
Wilson
Cass
Marion
Gregg
12
3
Cherokee
Robertson
Caldwell
Atascosa
Smith
Henderson
Milam
Travis
Comal
Bexar
Van
Zandt
Navarro
Williamson
Hays
Bandera
Rains
Ellis
Titus
Camp
Wood Upshur
Freestone
Coryell
Blanco
Bowie
Hopkins
10Rockwall
McLennan
Bell
Zavala
Hunt
Red River
Delta
Dallas Kaufman
De Witt
Maverick
Collin
Hill
Burnet
Kerr
Real
Tarrant
20
Hood
Lampasas
San Saba
Mason
Edwards
Parker
Hamilton
Gillespie
Val Verde
Fannin
Denton
15
Lamar
Grayson
Somervell
Mills
Concho
Cooke
Wise
Comanche
Coleman
Terrell
Presidio
Jack
Young
Stephens
Callahan
Crockett
Brewster
Clay Montague
Archer
Baylor
Shackleford
Taylor
Wichita
Newton
Hale
Morris
Lamb
Franklin
Bailey
8
Kenedy
Willacy
Cameron
16 • R ed River ADRC
17 • R IO-Net ADRC of the Lower Rio Grande Valley
18 • S outh Plains ADRC
19 • A DRC of Southeast/Deep East ADRC
20 • A DRC of Tarrant County
21 • West Central Texas ADRC
22 • West Texas ADRC
115
Aging and Disability Resource Center of the Capital Area (ADRC-CAP)
l
6800 Burleson Road
Bldg. 310, Suite 165
Austin, Texas 78744
512-916-6045
888-622-9111, Ext. 6045
DADS
Serves Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis and Williamson counties.
Aging, Disability and Transportation Resource Center of El Paso and Far West Texas
12100 Esther Lama Drive
El Paso, Texas 79936
915-298-7307
877-413-ADRC (2372)
Serves Brewster, Culberson, El Paso, Hudspeth, Jeff Davis and Presidio counties.
Aging and Disability Resource Center of Texoma
1117 Gallagher Drive, Suite 200 Sherman, Texas 75090
855-937-2372
Serves Bowie, Cass, Cooke Delta, Fannin, Franklin, Grayson, Hopkins, Lamar, Morris,
Red River and Titus counties.
Alamo Service Connection Aging and Disability Resource Center
8700 Tesoro Drive, Suite 700 San Antonio, Texas 78217
210-477-3275
866-231-4922
Serves Atascosa, Bandera, Bexar, Comal, Frio, Gillespie, Guadalupe, Karnes, Kendall, Kerr,
McMullen, Medina and Wilson counties.
Brazos Valley Aging and Disability Resource Center
3991 E. 29th St.
Bryan, Texas 77802
979-595-2800 ext. 2013
800-994-4000
Serves Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington counties.
Care Connection Aging and Disability Resource Center
4802 Lockwood Drive
877-393-1090
Serves Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty,
Matagorda, Montgomery, Walker, Waller and Wharton counties.
Central Texas Aging and Disability Resource Center
2180 N. Main St.
Belton, Texas 76513
254-770-2342
800-447-7169
Serves Bell, Coryell, Hamilton, Lampasas, Milam, Mills and San Saba counties.
116
Section IV
361-883-3935
Appendices
2910 Leopard St.
Corpus Christi, TX 78408
l
Coastal Bend Aging and Disability Resource Center
Serves Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak, Nueces, Refugio
and San Patricio counties.
South Texas Aging and Disability Resource Center
1002 Dicky Lane
Laredo, TX 78044
956-729-7000
Serves Dimmit, Edwards, Jim Hogg, Kinney, La Salle, Maverick, Real, Starr, Uvalde, Val Verde,
Webb, Zapata and Zavala counties.
Connect to Care
Metrocare Services
1380 River Bend Drive Dallas, Texas 7524
888-743-1202
Serves Dallas County.
Concho Valley Aging and Disability Resource Center
2809 Southwest Blvd.
San Angelo, Texas 76904
325-227-6624
877-233-4965
Serves Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan,
Schleicher, Sterling, Sutton and Tom Green counties.
East Texas Aging and Disability Resource Center
501 Pine Tree Road Longview, Texas 75604
www.etxadrc.org
903-295-5922
877-237-2268
Serves Anderson, Camp, Cherokee, Gregg, Harrison, Henderson, Marion, Panola, Rains,
Rusk, Smith, Upshur, Van Zandt and Wood counties.
Golden Crescent Aging and Disability Resource Center
1908 N. Laurent St.
855-937-2372
Serves Calhoun, De Witt, Goliad, Gonzales, Jackson, Lavaca and Victoria counties.
117
Heart of Texas Aging and Disability Resource Center
1514 South New Road
Waco, Texas 76711
254-292-1855
DADS
l
Serves Bosque, Falls, Freestone, Hill, Limestone and McLennan counties.
North Central Texas Aging and Disability Resource Center
North Central Texas Council of Governments
616 Six Flags Drive
Arlington, Texas 76011
OR
104 Pirate Drive
Granbury, Texas 76048
877-229-9084
Serves Collin, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto,
Parker, Rockwall, Somervell and Wise counties.
Red River Aging and Disability Resource Center
4309 Jacksboro Highway, Suite 200
Wichita Falls, Texas 76302
940-234-1644
Serves Archer, Armstrong, Baylor, Briscoe, Carson, Castro, Childress, Clay, Collingsworth, Cottle, Dallam, Deaf
Smith, Donley, Foard, Gray, Hall, Hansford, Hardeman, Hartley, Hemphill, Hutchinson, Jack, Lipscomb,
Montague, Moore, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Wheeler,
Wichita, Wilbarger and Young counties.
RIO-Net Aging and Disability Resource Center
255 S. Kansas Ave.
Weslaco Texas 78596
OR
1501 N. 28 Street, Suite A-2
Harlingen, Texas 78550
956-682-3481
Serves Cameron, Hidalgo and Willacy counties.
South Plains Aging and Disability Resource Center
1323 58th St.
806-993-8905
Serves Bailey, Cochran, Crosby, Dickens, Floyd, Garza, Hale, Hockley, King, Lamb, Lubbock, Lynn, Motley, Terry
and Yoakum counties.
118
Section IV
Appendices
2210 Eastex Freeway
Beaumont, Texas 77703
OR
210 Premier Drive
Jasper, Texas 75951
l
Aging and Disability Resource Center of Southeast/Deep East
409-924-3381
Serves Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine,
San Jacinto, Shelby, Trinity and Tyler counties.
Aging and Disability Resource Center of Tarrant County
1300 Circle Drive
Fort Worth, Texas 76119
888-730-ADRC (2372)
Serves Tarrant County.
West Central Texas Aging and Disability Resource Center
3702 Loop 322
Abilene Texas 79602
OR
901 Avenue B
Brownwood, Texas 76801
325-793-8440
Serves Brown, Callahan, Coleman, Comanche, Eastland, Fisher, Haskell, Jones, Kent, Knox, Mitchell, Nolan,
Runnels, Scurry, Shackelford, Stephens, Stonewall, Taylor and Throckmorton counties.
West Texas ADRC
319 Runnels St.
Big Spring, Texas 79720
800-687-0135
Serves Andrews, Borden, Crane, Dawson, Ector, Gaines, Glasscock, Howard, Loving, Martin, Midland, Pecos,
Reeves, Terrell, Upton, Ward and Winkler counties.
119
Dallam
Hartley
Moore
Oldham
Potter
Carson
Randall
Armstrong
DADS
l
Deaf Smith
Castro
Parmer
Hutchinson Roberts
Swisher
Hemphill
Gray
Wheeler
Donley
Collingsworth
Briscoe
Childress
Hall
Hardeman
Terry
Gaines
Andrews
Loving
Hudspeth
Culberson
Winkler
Ward
Ector
Lynn
Dawson
Martin
Dickens
Crosby
Borden
Howard
Scurry
Crane
Reeves
Upton
Reagan
Irion
Pecos
Jeff Davis
Nolan
Coke
Tom
Green
Stephens
1
Erath
Schleicher
Menard
Sutton
Kimble
Brown
McCulloch
Kinney
Johnson
Ellis
Bosque
Kendall
Medina
Lee
Gonzales
Wilson
Locations
Frio
Zavala
Karnes
La Salle
McMullen
Live Oak
Bee
Webb
3
Kleberg
Zapata
Jim Hogg
Brooks
Starr
Hidalgo
Kenedy
Willacy
Cameron
Foster Grandparent Program locations with counties served
1
2
3
4
120
•
•
•
•
Abilene
Austin
Corpus Christi
Denton
•
•
•
8•
5
6
7
Lubbock
Lufkin
Mexia
Richmond
Calhoun
Refugio
San Patricio
Jim
Wells Nueces
Duval
Jackson
Victoria
Goliad
Dimmit
by Grant Service Area
Atascosa
Aransas
Harris
8
Matagorda
Brazoria
Jasper
Tyler
San
Jacinto
Fort Bend
Wharton
De Witt
Maverick
Waller
Lavaca
6
Polk
Montgomery
Colorado
Guadalupe
Bexar
Grimes
Austin
Fayette
Caldwell
Comal
Walker
San
Augustine Sabine
Angelina
Trinity
Madison
Washington
Bastrop
Hays
Bandera
Uvalde
Travis
Shelby
Nacogdoches
Houston
Brazos
Panola
Rusk
Anderson
Burleson
Harrison
Gregg
Leon
Milam
Marion
Cherokee
Robertson
2
Smith
Freestone
Falls
Williamson
Blanco
Van
Zandt
Cass
Camp
Upshur
Wood
Limestone
Bell
Llano
Rains
Titus
Henderson
7
McLennan
Lampasas
Bowie
Hopkins
Navarro
Hill
Burnet
Kerr
Real
Tarrant
Red River
Delta
Hunt
Hood
Coryell
San Saba
Mason
Edwards
Collin
Parker
Hamilton
Gillespie
Val Verde
4
Somervell
Mills
Concho
Denton
Fannin
Rockwall
Dallas
Kaufman
Comanche
Coleman
Lamar
Grayson
Cooke
Wise
Palo
Pinto
Eastland
Callahan
Taylor
Terrell
Presidio
Jack
Young
Shackleford
Crockett
Brewster
Clay Montague
Archer
Throckmorton
Jones
Runnels
Wichita
Baylor
Stonewall Haskell
Fisher
Mitchell
Knox
King
Kent
Garza
Wilbarger
Foard
Newton
5
Cottle
Motley
Floyd
Lubbock
Hockley
Yoakum
El Paso
Hale
Morris
Cochran
Lamb
Franklin
Bailey
Hardin
Liberty
Orange
Jefferson
Chambers
Galveston
Section IV
l
Lufkin Foster Grandparent Program
4601 S. 1st St.
Abilene, Texas 79605
325-795-5704
Serves Taylor, Jones and Callahan counties
1210 S. Chestnut St.
Lufkin, Texas 75901
Austin Foster Grandparent Program
1601 Rutherford Lane
Austin, Texas 78754
512-873-6330
Serves Travis, Williamson, Hays
and Bell counties
Corpus Christi Foster Grandparent Program
4410 Dillon Lane, Suite 28
Corpus Christi, Texas 78415
361-878-7766
Serves Nueces County
Denton Foster Grandparent Program
Appendices
Abilene Foster Grandparent Program
936-633-3767
Serves Angelina, Tyler, Polk
and Nacogdoches counties
Mexia Foster Grandparent Program
939 Industrial Blvd.
Mexia, Texas 76667
254-562-4257
Serves Limestone, Freestone, Navarro
and McLennans counties
Richmond Foster Grandparent Program
117 Lane Drive, Suite 50
Rosenberg, Texas 77471
281-344-3515
Serves Fort Bend and Wharton counties
3600 E. McKinney St., Suite 200
Denton, Texas 76209
940-484-5398
Serves Denton County
Lubbock Foster Grandparent Program
6302 Lola Ave.
806-783-6670
Serves Lubbock County
121
Hartley
Moore
Oldham
Potter
Loving
Culberson
Winkler
Ward
33
Lynn
Dawson
Andrews
Hudspeth
Lubbock
Terry
Gaines
16 El Paso
12
Hale
Hockley
Yoakum
Ector
Armstrong
Donley
Collingsworth
Martin
31
Midland
Upton
Childress
Hall
Hardeman
Floyd
Motley
Cottle
Crosby
Dickens
King
Kent
Garza
Borden
Howard
39
Scurry
Mitchell
Glasscock Sterling
Crane
Reeves
Reagan
Irion
Nolan
5
Tom
Green
Throckmorton
Runnels
Coleman
Presidio
Val Verde
Brewster
Kerr
Edwards
Real
21
Blanco
Hays
Kendall
Bandera
Kinney
Medina
Uvalde
3
9
Guadalupe
Location
by County
and LIDDA Region
1 • ACCESS
2 • Andrews Center
3 • Alamo Local Authority
4 • Austin Travis County Integral Care
5 • Betty Hardwick Center
6 • Bluebonnet Trails Community Services
7 • Border Region Behavioral Health Center
8 • Burke Center
9 • Camino Real Community Services
10 • C enter for Life Resources
11 • C entral Counties Services
12 • C entral Plains Center
13 • C oastal Plains Community Center
14 • C ommunity Healthcore
15 • D enton County MHMR Center
16 • E mergence Health Network
17 • G ulf Bend Center
18 • G ulf Coast Center
122
Frio
Zavala
Atascosa
Karnes
Goliad
Dimmit
La Salle
McMullen
Live Oak
Bee
8
Angelina
Austin
Waller
Jackson
San
Jacinto
2626
34
Hardin
Chambers
18
Galveston
Brazoria
Matagorda
Calhoun
Refugio
Aransas
San Patricio
7
Webb
Duval
Jim
Wells
13
Nueces 27
Kleberg
Zapata
Jim Hogg
Brooks
Starr
Hidalgo
38
19 • H eart of Texas Region MHMR Center
20 • H elen Farabee Regional Centers
21 • H ill Country Community Mental Health and
Developmental Disabilities Centers
22 • L akes Regional MHMR
23 • L ifePath Systems
24 • M
etrocare SERVICES
25 • M
HMR Authority of Brazos Valley
26 • M
HMR Authority of Harris County
27 • B ehavioral Health Center of Nueces County
28 • M
HMR of Tarrant County
29 • M
HMR Services for the Concho Valley
Jasper
Tyler
Liberty
Harris
Fort Bend
Wharton
17 Victoria
Polk
37
Montgomery
Washington
Wilson
De Witt
Maverick
Shelby
San
Augustine Sabine
Trinity
Walker
25 Grimes
Lavaca
Panola
1
Madison
Colorado
Gonzales
Rusk
Houston
Brazos
Fayette
Caldwell
Comal
Bexar
2
Nacogdoches
Burleson
Bastrop
Harrison
Cherokee
Robertson
Lee
4
14
Gregg
Leon
Milam
Cass
Marion
Upshur
Smith
Henderson
Falls
6
Gillespie
22
Limestone
11
Travis
Camp
Rains Wood
Rockwall
Anderson
19
Williamson
Kimble
Hunt
Titus
Freestone
Bell
Burnet
Llano
Bowie
Hopkins
Navarro
McLennan
Lampasas
Red River
Delta
Van
Kaufman Zandt
Hill
Coryell
Menard
Terrell
Ellis
Hamilton
McCulloch San Saba
Mason
Johnson
Bosque
Comanche
Mills
Concho
Crockett
Sutton
10
30 Somervell
Brown
Dallas
28 24
Hood
Erath
Collin
Tarrant
Parker
Lamar
Fannin
23
15
Wise
Palo
Pinto
Eastland
Callahan
Taylor
Young
36
Grayson
Cooke
Denton
Jack
Stephens
Shackleford
Clay Montague
Archer
Baylor
Haskell
Jones
29
20
Knox
Fisher
Coke
Wilbarger Wichita
Foard
Stonewall
Schleicher
Pecos
Jeff Davis
Wheeler
Briscoe
Swisher
Lamb
Cochran
Gray
Carson
Randall
Castro
Bailey
Hemphill
35
Deaf Smith
Parmer
Hutchinson Roberts
Newton
DADS
l
Appendices
Morris
l
Dallam
Franklin
Section IV
Local Intellectual and Developmental Disability Authorities
Kenedy
Willacy
Cameron
30 • P ecan Valley Centers
31 • P ermian Basin Community Centers
32 • S pindletop Center
33 • S tarcare Specialty Health System
34 • Texana Center
35 • Texas Panhandle Centers
36 • Texoma Community Center
37 • Tri-County Services
38 • Tropical Texas Behavioral Health
39 • W
est Texas Centers
Orange
32
Jefferson
Section IV
l
ACCESS903-586-5507
Mailing: Appendices
Ted Debbs • executive director
913 N. Jackson St.
Jacksonville, Texas 75766
Physical:Same
Catchment area: Anderson and Cherokee counties
Andrews Center
903-597-1351
Waymon Stewart • executive director
Mailing: P.O. Box 4730
Tyler, Texas 75712
Physical:
2323 W. Front St.
Tyler, Texas 75702-7747
Catchment area: Henderson, Rains, Smith, Van Zandt and Wood counties
210-362-5200
Diane Rath • executive director
Mailing: 8700 Tesoro, Ste. 700
Physical:Same
Catchment area: Bexar County
Austin Travis County Integral Care
512-447-4141
David L. Evans • executive director
Austin, Texas 78764
Physical:
1430 Collier St.
Austin, Texas 78704
Catchment area: Travis County
325-690-5100
Jenny Goode • executive director
Mailing: 2616 S. Clack
Abilene, Texas 79606-1545
Physical:Same
Catchment area: Taylor, Jones, Callahan, Shackelford and Stephens counties
123
512-255-1720
Andrea Richardson • executive director
DADS
l
Mailing: 1009 N. Georgetown St.
Round Rock, Texas 78664
Physical:Same
Catchment area: Bastrop, Burnet, Caldwell, Fayette, Gonzales, Guadalupe, Lee,
and Williamson counties
Border Region Behavioral Health Center
956-794-3000
Daniel Castillon • executive director
Laredo, Texas 78044-1835
Physical:
1500 Pappas St.
Laredo, Texas 78041
Catchment area: Webb, Jim Hogg, Zapata and Starr counties
Burke Center
936-639-1141
Susan L. Rushing • executive director
Mailing: 2001 S. Medford Drive
Lufkin, Texas 75901
Physical:Same
Catchment area: Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San Augustine,
San Jacinto, Shelby, Trinity and Tyler counties
210-357-0300
Emma C. Garcia • executive director
Lytle, Texas 78052
Physical:
19965 FM 3175 N.
Lytle, Texas 78052
Catchment area: Atascosa, Dimmit, Frio, La Salle, Karnes, Maverick, McMullen, Wilson and
Zavala counties
325-646-9574
Dion White • executive director
Physical:
408 Mulberry
Catchment area: Brown, Coleman, Comanche, San Saba, Mills, Eastland and McCulloch counties
124
Section IV
254-298-7000
l
Mailing: Appendices
Ray Helmcamp • executive director
304 S. 22nd St.
Temple, Texas 76501-4726
Physical:Same
Catchment area: Bell, Coryell, Hamilton, Lampasas and Milam counties
806-293-2636
Ron Trusler • executive director
Mailing: 2700 Yonkers
Plainview, Texas 79072-1892
Physical:Same
Catchment area: Hale, Lamb, Swisher, Bailey, Parmer, Castro, Floyd, Motely and Briscoe counties
361-777-3991
Mark Durand • executive director
Portland, Texas 78374-1185
Physical:
200 Marriott Drive
Portland, Texas 78374-2213
Catchment area: Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak
and San Patricio counties
903-758-2471
Inman White • executive director
Longview, Texas 75608
Physical:
107 Woodbine Place
Longview, Texas 75601
Catchment area: Gregg, Harrison, Marion, Panola, Rusk, Bowie, Cass, Red River
and Upshur counties
940-381-5000
Pam Gutierrez • executive director
Denton, Texas 76202
Physical:
2519 Scripture
Denton, Texas 76201
Catchment area: Denton County
125
915-887-3410
DADS
l
Kristin Daugherty • executive director
Physical:
1600 Montana Ave.
Catchment area: El Paso County
Gulf Bend Center
361-575-0611
Jeff Tunnell • executive director
Mailing: 6502 Nursery Drive, Ste. 100
Physical:Same
Catchment area: Calhoun, DeWitt, Goliad, Jackson, Lavaca, Refugio and Victoria counties
Gulf Coast Center
409-763-2373
G. Michael Winburn • executive director
Mailing and Physical: 123 Rosenberg, Ste. 6
Galveston, Texas 77550
Catchment area: Brazoria and Galveston counties
254-752-3451
Barbara Tate • executive director
Waco, Texas 76703-0890
Physical:
110 S. 12th St.
Waco, Texas 76701
Catchment area: McLennan, Bosque, Falls, Freestone, Hill and Limestone counties
Helen Farabee Regional Centers
940-397-3143
Raymond A. Atkins • executive director
Wichita Falls, Texas 76307-8266
Physical:
1000 Brook St.
Wichita Falls, Texas 76301
Catchment area: Archer, Baylor, Childress, Clay, Cottle, Dickens, Foard, Hardeman, Haskell, Jack,
King, Knox, Montague, Stonewall, Throckmorton, Wichita, Wilbarger, Wise and
Young counties
126
Section IV
830-792-3300
l
Appendices
Ross Robinson • executive director
Mailing and Physical: 819 Water St. Ste. 300
Kerrville, Texas 78028
Catchment area: Bandera, Comal, Blanco, Edwards, Gillespie, Hays, Kendall, Kerr, Kimble,
Kinney, Llano, Mason, Medina, Menard, Real, Schleicher, Sutton, Uvalde and Val
Verde counties
972-388-2000
John Delaney • executive director
Terrell, Texas 75160
Physical:
400 Airport Road
Terrell, Texas 75160
Catchment area: Camp, Delta, Franklin, Hopkins, Kaufman, Lamar, Morris, Rockwall, Titus,
Hunt, Ellis and Navarro counties
LifePath Systems
972-562-9647
Dr. J. Randy Routon • executive director
McKinney, Texas 75070
Physical:
1416 N. Church St.
McKinney, Texas 75069
Catchment area: Collin County
Metrocare Services
214-743-1200
John Burruss, M.D. • executive director
Mailing and Physical: 1380 River Bend Drive
Dallas, Texas 75247-4914
Catchment area: Dallas County
979-822-6467
Bill Kelly • executive director
Bryan, Texas 77805
Physical:
1504 S. Texas Ave.
Bryan, Texas 77802
Catchment area: Brazos, Grimes, Madison, Washington, Burleson, Leon and Robertson counties
127
713-970-7000
DADS
l
Dr. Steven B. Schnee • executive director
Houston, Texas 77265-5381
Physical:
7011 Southwest Freeway
Catchment area: Harris County
Behavioral Health Center of Nueces County
361-886-6900
Diane Lowrance • executive director
Mailing: 1630 S. Brownlee
Corpus Christi, Texas 78404-3178
Physical:Same
Catchment area: Nueces County
817-569-4300
Susan Garnett • executive director
Physical:
3840 Hulen Tower North
Catchment area: Tarrant County
325-658-7750
Greg Rowe • executive director
Mailing: 1501 W. Beauregard
San Angelo, Texas 76901-4004
Physical:Same
Catchment area: Coke, Concho, Crockett, Irion, Reagan, Sterling and Tom Green counties
Pecan Valley Centers for Behavoiral and Developmental Healthcare
817-579-4400
Coke Beatty • executive director
128
Physical:
2101 W Pearl St.
Catchment area: Erath, Somervell, Palo Pinto, Parker, Hood and Johnson counties
Section IV
432-570-3333
l
Appendices
Ramona Thomas • executive director
Mailing and Physical: 401 E. Illinois, Ste. 401
Midland, Texas 79701
Catchment area: Brewster, Culberson, Ector, Hudspeth, Jeff Davis, Midland, Pecos
and Presidio counties
Spindletop Center
409-784-5400
Dr. N. Charles Harris • executive director
Beaumont, Texas 77704-3846
Physical:
655 S. 8th Street
Catchment area: Jefferson, Orange, Hardin and Chambers counties
806-766-0310
Cathy Pope • executive director
Lubbock, Texas 79408-2828
Physical:
1602 10th St.
Catchment area: Cochran, Crosby, Hockley, Lynn and Lubbock counties
Texana Center
281-239-1300
George Patterson • executive director
Mailing and Physical: 4910 Airport Ave.
Rosenberg, Texas 77471
Catchment area: Wharton, Austin, Colorado, Fort Bend, Matagorda and Waller counties
806-358-1681
Bud Schertler • executive director
Amarillo, Texas 79116-3250
Physical:
901 Wallace Blvd.
Amarillo, Texas 79106
Catchment area: Dallam, Sherman, Hansford, Ochiltree, Lipscomb, Hartley, Moore, Hutchinson,
Roberts, Hemphill, Oldham, Potter, Carson, Gray, Wheeler, Deaf Smith, Randall,
Armstrong, Collingsworth, Donley and Hall counties
129
903-957-4701
DADS
l
Daniel Thompson • executive director
Sherman, Texas 75091-1087
Physical:
315 W. McLain
Sherman, Texas 75092
Catchment area: Cooke, Fannin and Grayson counties
Tri-County Services
936-521-6100
Evan Roberson • executive director
Conroe, Texas 77305-3067
Physical:
1506 FM 2854
Conroe, Texas 77304
Catchment area: Liberty, Montgomery and Walker counties
956-289-7000
Terry Crocker • executive director
Mailing: P.O. Drawer 1108
Edinburg, Texas 78540-1108
Physical:
1901 S. 24th Ave.
Edinburg, Texas 78539
Catchment area: Cameron, Hidalgo and Willacy counties
West Texas Centers
432-263-0007
Shelley Smith • executive director
Mailing: 319 Runnels
Big Spring, Texas 79720
Physical:Same
Catchment area: Andrews, Borden, Crane, Dawson, Fisher, Gaines, Garza, Glasscock, Howard,
Kent, Loving, Martin, Mitchell, Nolan, Reeves, Runnels, Scurry, Terrell, Terry,
Upton, Ward, Winkler and Yoakum counties
130
Section IV
l
Hartley
Moore
Oldham
Potter
Carson
Randall
Armstrong
Deaf Smith
Castro
Parmer
Hutchinson Roberts
Swisher
Hemphill
Gray
Wheeler
Donley
Collingsworth
Briscoe
Appendices
Dallam
Childress
Hall
Hardeman
Hockley
Lubbock
Yoakum
7
Terry
Gaines
Andrews
El Paso
6
Loving
Hudspeth
Culberson
Winkler
Ward
Ector
Lynn
Dawson
Martin
Floyd
Motley
Cottle
Crosby
Dickens
King
Borden
Howard
Scurry
Mitchell
Upton
Reagan
Irion
Jones
Nolan
1
Coke
Tom
Green
Schleicher
Pecos
Jeff Davis
Fisher
Val Verde
McCulloch
Johnson
Ellis
Kendall
Bexar
Uvalde
13
Medina
Lee
Center Locations
with Counties
and Catchment Areas
Zavala
Dimmit
Frio
Lavaca
Karnes
McMullen
Live Oak
Bee
Webb
Duval
10
Nueces
Fort Bend
Jasper
Hardin
Liberty
Orange
Jefferson
Harris
Waller
Tyler
Chambers
Galveston
Brazoria
Matagorda
Calhoun
Refugio
San Patricio
Jim
Wells
Jackson
Victoria
Polk
San
Jacinto
Montgomery
Wharton
Wilson
Goliad
La Salle
Grimes
3
Guadalupe
Atascosa
8Angelina
San
Augustine Sabine
Trinity
Walker
Austin
De Witt
Maverick
Panola
Shelby
Madison
Colorado
Gonzales
Harrison
Nacogdoches
Washington
Fayette
Caldwell
Comal
Bandera
Rusk
Houston
Brazos
Bastrop
Hays
Kerr
Real
Blanco
Gregg
Freestone
Burleson
2
Travis
Marion
Cherokee
Robertson
Williamson
Kimble
Smith
Leon
Milam
Llano
Cass
Camp
Wood Upshur
Anderson
9
Bell
Mason
Van
Zandt
Titus
Henderson
Falls
Burnet
Hopkins
Rains
Limestone
McLennan
Coryell
Bowie
Navarro
Hill
Lampasas
San Saba
Menard
Edwards
Kinney
Hood
Hamilton
Gillespie
Presidio
Tarrant
Red River
Delta
Hunt
Parker
Bosque
Mills
Concho
Collin
Somervell
Brown
Fannin
Rockwall
Dallas
Kaufman
Comanche
Coleman
Terrell
Brewster
Erath
Eastland
Callahan
5
Wise
Palo
Pinto
Lamar
Grayson
Cooke
Denton
Jack
Young
Stephens
Shackleford
Crockett
Sutton
Clay Montague
Archer
Throckmorton
Taylor
Runnels
Wichita
Baylor
12
Crane
Reeves
Knox
Stonewall Haskell
Kent
Garza
Wilbarger
Foard
Newton
Hale
Morris
Cochran
Lamb
Franklin
Bailey
Aransas
4
Kleberg
Zapata
Jim Hogg
Brooks
Starr
Hidalgo
Kenedy
Willacy
11Cameron
1
2
3
4
5
6
7
•
•
•
•
•
•
•
Abilene State Supported Living Center
Austin State Supported Living Center
Brenham State Supported Living Center
Corpus Christi State Supported Living Center
Denton State Supported Living Center
El Paso State Supported Living Center
Lubbock State Supported Living Center
8 • Lufkin State Supported Living Center
9 • Mexia State Supported Living Center
10 • Richmond State Supported Living Center
11 • Rio Grande State Center
12 • San Angelo State Supported Living Center
13 • San Antonio State Supported Living Center
131
State Facility
Local Intellectual and
Developmental Disability Authority
Abilene State Supported Living Center
DADS
l
2501 Maple St.
Linda Hinshaw • director
325-692-4053
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Bluebonnet Trails Services
Austin State Supported Living Center
2203 W. 35th St.
Austin, Texas 78703
Laura Cabazon-Braly • director
512-454-4731
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ill Country Mental Health and
H
Developmental Disabilities Centers
Brenham State Supported Living Center
4001 Highway 36 South
Brenham, Texas 77833
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Tri-County MHMR Services
Iva Benson • director
979-836-4511
Corpus Christi State Supported Living Center
902 Airport Blvd.
Mark Cazalas • director
361-888-5301
order Region Behavioral Health Center
B
l Coastal Plains Community Center
l Gulf Bend Center
l B ehavioral Health Center of Nueces County
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Denton State Supported Living Center
3980 State School Road
Denton, Texas 76210
Nancy Condon • director
940-891-0342
El Paso State Supported Living Center
6700 Delta Drive
Metrocare Services
l Lakes Regional MHMR Center
l LifePath Systems
l Texoma Community Centers
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Al Barrera • interim director
915-782-6300
Lubbock State Supported Living Center
3401 University Ave.
Libby Allen • director
806-763-7041
132
entral Plains Center
C
l Helen Farabee Centers
l Starcare Specialty Health System
l Texas Panhandle Centers
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Section IV
State Facility
Local Intellectual and
Developmental Disability Authority
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6844 Highway 69 North
Pollok, Texas 75969
Gale Wasson • director
936-634-3353
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ACCESS
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Andrews Center
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Burke Center
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Spindletop Center
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Gulf Coast Center
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Texana Center
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West Texas Centers
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Alamo Area Local Authority
Appendices
Lufkin State Supported Living Center
Mexia State Supported Living Center
540 Chapel Drive
Mexia, Texas 76667
Mike Davis • director
254-562-2821
Richmond State Supported Living Center
2100 Preston
Richmond, Texas 77469
Al Barrera • director
281-232-2075
Rio Grande State Center
1401 Rangerville Road, Bldg. 503
Harlingen, Texas 78552
Sonia Hernandez-Keeble • director
956-364-8000
San Angelo State Supported Living Center
6711 North U.S. Highway 87
Carlsbad, Texas 76934
Charles Njemanze • director
325-465-4391
San Antonio State Supported Living Center
6711 S. New Braunfels Ave.
Ralph Henry • director
210-532-9610
133
Regional Directors
DADS
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Regulatory Services
Regional Directors
Assistant Regional Directors
John Bertrand • Region 1
5806 34th St.
Elizabeth Tomme • Regions 2, 9 and 10
4601 S. 1st St.
P.O. Box 521
806-783-6530
Roger Barnes • Regions 2, 9 and 10
4601 S. 1st, P.O. Box 521
325-795-5550
Paul J. Campbell • Region 3
2561 Matlock Road
817-792-7229
Dorothea Raiford • Regions 4 and 5
285 Liberty St.
409-951-3236
Mark Kendall • Region 6
5425 Polk St.
713-767-2291
Elizabeth Thomas • Region 7
10205 N. Lamar Blvd.
Austin, Texas 78753
512-908-9641
VACANT • Regions 8 and 11
1067 Bandera Road
210-438-6300
134
325-795-5577
Nicole McCown • Region 3
2561 Matlock Road
817-792-7259
Shirley Turner • Regions 4 and 5
3303 Mineola Highway
Tyler, Texas 75702
903-533-4454
Carolyn Kirkwood • Region 6
5425 Polk St.
713-767-2306
Paula McHenry • Region 7
10205 N. Lamar Blvd.
Austin, Texas 78753
512-908-9635
Christine Strukel • Regions 8 and 11
4410 Dillon Lane, Suite 28
361-878-7712
Section IV
William Fuller • Regions 1 and 10
401 E. Franklin, 4th Floor,
915-834-7563
Rea Barry • Regions 2 and 9
4601 S. 1st St.
P.O. Box 521
325-795-5724
Karen Brock • Region 3
801 S. State Hwy. 161, Suite 700
Grand Prairie, Texas 75051
972-337-6140
Lance Duckworth • Regions 4 and 5
302 E. Rieck Road,
Tyler, Texas 75703
Janina Sodus • Region 6
Appendices
Regional Directors
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Community Services
5425 Polk St., Suite 490
713-767-2155
Michael Weaver • Region 7
14000 Summit Drive, Suite 100
Austin, Texas 78728
512-834-3436
Michael Weaver • Region 8
11307 Roszell Road
210-619-8149
Paul Ebrom • Region 11
2520 S. Veterans Blvd.
Edinburg, Texas 78539
956-316-8341
903-509-5139
135
Texas Counties by Region
Hartley
Moore Hutchinson Roberts Hemphill
DADS
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Dallam
1
Potter
Oldham
Deaf Smith
Randall Armstrong
Castro
Parmer
Gray
Wheeler
Donley
Collingsworth
Carson
Swisher
Briscoe
Childress
Hall
Hardeman
Lubbock
Cochran Hockley
Yoakum
Terry
Andrews
Loving
Hudspeth
10
Culberson
Winkler
Ward
Reeves
Lynn
Martin
Motley
Cottle
Crosby
Dickens
King
Kent
Garza
Dawson
Gaines
✪ El Paso
✪
Floyd
Borden
Howard
9
Scurry
Ector
Crane
Upton
Reagan
Irion
Jones
Coke
Taylor
2
Sutton
Palo
Pinto
Stephens
Erath
Eastland
Callahan
McCulloch
✪Regional Offices
Zavala
Kendall
Bandera
8
Dimmit
Medina
Lavaca
Victoria
Live Oak
Bee
Webb
11
Zapata Jim Hogg
Jim
Wells
6
Waller
✪
Starr
Hidalgo
✪
✪
Orange
Jefferson
Chambers
Galveston
Brazoria
Matagorda
Calhoun
Refugio
Aransas
Nueces
Kenedy
Willacy
Cameron
DADS Regions
136
Jasper
Hardin
Liberty
Kleberg
Brooks
San
Augustine Sabine
Tyler
Harris
Fort Bend
Wharton
Jackson
Polk
San
Jacinto
Montgomery
Colorado
San Patricio
Duval
Austin
Fayette
Karnes
McMullen
Grimes
5
Angelina
Trinity
Walker
Washington
Bastrop
Goliad
La Salle
Shelby
Nacogdoches
Madison
Burleson
Lee
Wilson
Atascosa
Panola
Rusk
Houston
Brazos
De Witt
Frio
Harrison
Gregg
✪
Leon
Milam
Gonzales
✪
4
Marion
Cherokee
Limestone
Guadalupe
Bexar
Smith
Cass
Camp
Upshur
Anderson
Robertson
Caldwell
Comal
Van
Zandt
Wood
Henderson
Falls
Travis
Hays
Kerr
7
✪
Hopkins
Rains
Titus
Freestone
Williamson
Blanco
Bowie
Navarro
Bell
Llano
Red River
Delta
Hunt
Ellis
McLennan
Coryell
Kimble
Uvalde
Collin
Hill
Bosque
Burnet
Real
Maverick
Johnson
✪
Lampasas
San Saba
Mason
Edwards
Kinney
Hood
Hamilton
Gillespie
Val Verde
Tarrant
Comanche
Menard
Terrell
Presidio
Parker
Fannin
Rockwall
Dallas
Kaufman
Somervell
Mills
Concho
3
Wise
Lamar
Grayson
Cooke
Denton
Jack
Young
Runnels Coleman
Brown
Tom
Green
Clay Montague
Archer
Throckmorton
Crockett
Brewster
Wichita
Baylor
Shackleford
✪
Nolan
Schleicher
Pecos
Jeff Davis
Knox
Stonewall Haskell
Fisher
Mitchell
Wilbarger
Foard
Newton
Hale
Morris
Lamb
Franklin
Bailey
Region Number/Name
Headquarters Location
Region Number/Name
Headquarters Location
1 High Plains
Lubbock
7 Central Texas
Austin
2 Northwest Texas
Abilene
8 Upper South Texas
San Antonio
3 Metroplex
Grand Prairie
9 West Texas
Abilene
4 Upper East Texas
Tyler
10 Upper Rio Grande
El Paso
5 Southeast Texas
Beaumont
11 Lower South Texas
Edinburg
6 Gulf Coast
Houston
Section IV
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Region 1 • High Plains
CollingsworthGarza
Hockley
Bailey
Crosby
HutchinsonMotley
Gray
Moore
Roberts
Sherman
Briscoe Dallam Hale
King
OchiltreeSwisher
Carson
Deaf Smith
Lamb
Oldham
Castro
Dickens HansfordLipscombParmer Wheeler
Hall
ChildressDonley Hartley Lubbock Potter
Cochran Floyd
HemphillLynn
Appendices
Armstrong
Terry
Yoakum
Randall
Region 2 • Northwest Texas
Archer ColemanFoard
Kent
Runnels Taylor
Baylor
ComancheHardemanKnox
Scurry
Brown
Cottle
ShackelfordWichita
Haskell
Mitchell
Throckmorton
Callahan Eastland Jack
MontagueStephens Wilbarger
Clay
Jones
Nolan
StonewallYoung
Palo Pinto
Fisher
Region 3 • Metroplex
Collin
Ellis
Grayson
Johnson
Somervell
Cooke
Erath
Hood
KaufmanParker Tarrant
Dallas
Fannin Hunt
Navarro RockwallWise
Denton
Region 4 • Upper East Texas
Anderson
Cherokee
Harrison
Marion
Red River
Upshur
Bowie
Delta
Henderson
Morris
Rusk
Van Zandt
Camp
FranklinHopkinsPanola Smith
Wood
Cass Gregg LamarRains Titus
Region 5 • Southeast Texas
AngelinaJasper
Newton Sabine Shelby Trinity
Hardin
Jefferson
Orange
Houston
NacogdochesPolk
San Augustine San Jacinto
Tyler
137
Region 6 • Gulf Coast
DADS
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Austin
Brazoria
Chambers
Colorado
Fort Bend
Galveston
Harris
Liberty
Matagorda
MontgomeryWaller
Walker
Wharton
Region 7 • Central Texas
Bastrop
Bell
Blanco
Bosque
Brazos
BurlesonFayette Hill
Llano Robertson
Burnet
Freestone
Lampasas
McLennan
San Saba
CaldwellGrimes Lee
MadisonTravis
Coryell HamiltonLeon
Milam Washington
Falls
Hays
LimestoneMills
Williamson
Region 8 • Upper South Texas
Atascosa
DeWitt
Goliad
Kendall
Bandera Dimmit GonzalesKerr
Bexar
Edwards GuadalupeKinney
CalhounFrio
Jackson LaSalle
Comal GillespieKarnes Lavaca
Maverick
Medina
Real
Uvalde
Val Verde
Victoria
Wilson
Zavala
Region 9 • West Texas
Andrews
Crocket Howard Borden
Dawson
Irion
Coke
Ector
Kimble
Concho Gaines Loving
Crane
GlasscockMartin
Mason Reagan Terrell
McCulloch
Reeves
Tom Green
Menard SchleicherUpton
MidlandSterling Ward
Pecos
Sutton Winkler
Region 10 • Upper Rio Grande
Brewster
Culberson
El Paso
Hudspeth
Jeff Davis
Presidio
Live Oak
McMullen
Nueces
Refugio
San Patricio
Starr
Webb
Willacy
Zapata
Region 11 • Lower South Texas
Aransas
Bee
Brooks
Cameron
138
Duval
Hidalgo
Jim Hogg
Jim Wells
Kenedy
Kleberg
Section IV
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STAR+PLUS Program
Appendices
STAR+PLUS is a Texas Medicaid program designed to
integrate delivery of acute and long-term services through
a managed care model. The STAR+PLUS program provides
a continuum of care through a licensed managed care
organization (MCO).
STAR+PLUS Enrollment
The Texas Health and Human Services Commission (HHSC)
contracts with an independent organization, called an
enrollment broker, to enroll people in the STAR+PLUS
program and to ensure the MCOs do not market directly to
potential STAR+PLUS members. The state’s enrollment broker
is MAXIMUS.
People who are eligible for Supplemental Security Income (SSI) receive an enrollment packet with
instructions to select an MCO and a primary care provider. Under the HHSC STAR+PLUS contract,
each MCO provides the same array of Medicaid acute care services and LTSS to Medicaid-only
members. Dual eligible (i.e., Medicare and Medicaid) members will continue to receive acute care
services through Medicare and will receive long-term services and supports (LTSS) services through
their STAR+PLUS MCO.
A STAR+PLUS member may be eligible to receive the following LTSS services in the
STAR+PLUS program:
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H
CBS STAR+PLUS Waiver – An array of services is available to members through this Medicaid waiver
program who would otherwise qualify for nursing facility care.
D ay Activity and Health Services (DAHS) – DADS can administer DAHS services, even to those receiving
full Medicaid, if they are unable to access the program through managed care.
P rimary Home Care (PHC) – In the STAR+PLUS program, PHC services are referred to as Personal
Assistance Services (PAS) and do not include Community Attendant Services (CAS) or Family
Care (FC). DADS cannot administer Title XIX PHC services to eligible STAR+PLUS members.
DADS can administer PHC services to people receiving full Medicaid if they are pending managed
care enrollment and meet the expedited or immediate criteria and are shown to be a candidate for
STAR+PLUS enrollment. DADS continues to operate CAS and FC statewide.
Comprehensive information about the STAR+PLUS program and MCOs, can be found at
www.hhsc.state.tx.us/medicaid/managed-care/starplus/
139
STAR Program in the Medicaid Rural Service Area
DADS
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The STAR program in the Medicaid Rural Service Area (Medicaid RSA) is an acute care Medicaid model
serving people on Medicaid who do not receive Medicare and were covered by the Primary Care Case
Management (PCCM) program prior to March 1, 2012 or July 1, 2012. This includes those who receive
services through a DADS 1915(c) waiver program.
STAR Medicaid RSA Enrollment
As with STAR+PLUS, HHSC contracts with MAXIMUS to enroll people in the STAR Medicaid RSA
program. Eligible recipients in a STAR Medicaid RSA service area receive an enrollment packet for
selection of an MCO and a primary care provider. Under the HHSC STAR Medicaid RSA contract,
each MCO provides the same array of Medicaid acute care services to eligible members.
Comprehensive information about STAR Medicaid RSA and MCOs can be found at
www.hhsc.state.tx.us/medicaid/managed-care/star/
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Section IV
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Glossary
Appendices
§1915(c) Medicaid Waiver – The provision of the Social
Security Act that authorizes the Secretary of Health and
Human Services to grant waivers of certain Medicaid
statutory requirements so that a state may furnish home and
community-based services to Medicaid beneficiaries who
need a level of institutional care that is provided in a hospital,
nursing facility or intermediate care facility.
Abuse – The infliction of injury, unreasonable confinement,
intimidation, punishment, mental anguish, sexual abuse or
exploitation of a person. Types of abuse include:
l Physical abuse (a physical act by one person that may cause
physical injury to another).
l Psychological abuse (an act, other than verbal, that may
inflict emotional harm, invoke fear or humiliate, intimidate,
degrade or demean someone).
l Sexual abuse (an act or attempted act such as rape, incest, sexual molestation, sexual exploitation,
sexual harassment or inappropriate or unwanted touching of another).
l Verbal abuse (using words to threaten, coerce, intimidate, degrade, demean, harass or
humiliate someone).
Active treatment – A continual treatment program that each ICFs/IID resident must receive, which
includes aggressive, consistent implementation of a program of specialized and generic training,
treatment, health services and related services, that is directed toward the acquisition of the behaviors
necessary for the resident to function with as much self-determination and independence as possible
while preventing or decelerating regression or loss of current optimal functional status.
Activities of daily living – Basic personal everyday activities that include bathing, dressing, transferring
(e.g., from bed to chair), toileting, mobility and eating.
Adaptive aids – Devices, controls or appliances that address a person’s specific needs and enable him or
her to increase his or her ability to perform activities of daily living or to perceive, control
or communicate with the environment in which he or she lives.
Adaptive behavior – In general, the effectiveness or degree to which someone meets the standards
of personal independence and social responsibility expected of his or her age and cultural group.
Administrative hearing – A proceeding in which a person’s legal rights, duties or privileges are
to be determined by a state agency after an opportunity for an adjudicative hearing.
Adult – A person 18 years or older, or an emancipated minor.
Adult Foster Care (AFC) – A service that provides a 24-hour living arrangement with supervision
in a home for people who are unable to continue living independently in their own homes because
of physical, mental or emotional limitations.
141
Advocate – A person who represents his or her own interests publicly or a person who represents the
interests of another.
Advance notice – A written statement describing the intent of action the state will bring against a person
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or his or her legally authorized representative at least 10 days before the date of action.
DADS
Agency model – A program payment model in which the provider agency is the employer of record.
Aging and Disability Resource Centers (ADRCs) – 22 resource centers, available statewide, which serve as
a key point of access to person-centered long-term services and supports (LTSS) information, referrals
and assistance.
Ambulatory – Ability to walk independently.
Amount, duration and scope – How a Medicaid benefit is defined and limited in a state’s Medicaid plan.
Each state defines these parameters, so state Medicaid plans vary in what they cover.
Annual renewal – The annual activity of re-determining someone’s eligibility for waiver services.
Appeal – The formal process by which an applicant, provider, person or the applicant or person’s parent,
guardian or legally authorized representative requests a review of an adverse action.
Applicant – Someone who has requested services and eligibility for services is in the process of being
determined.
Applied income – That portion of a person’s income that must be applied toward the cost of
institutional care.
Area agencies on aging (AAA) – The 28 agencies that provide services to help older Texans, their family
members and caregivers receive the information and assistance they need in locating and accessing
community services.
Assisted living facility (ALF) – A residential facility that provides residents personal care and other
assistance as needed with activities of daily living and instrumental activities of daily living but does
not provide round-the-clock skilled nursing services. Assisted living facilities generally provide less
intensive care than nursing facilities and emphasize resident privacy and choice.
Attendant – A person employed to perform personal care or other non-skilled services for another.
Authorization – State approval of a provider to deliver services.
Autism – A pervasive developmental disorder characterized by qualitative impairment in reciprocal
social interactions; qualitative impairment in verbal and non-verbal communications and in
imaginative thinking; markedly restricted repertoire of activities and interests; and onset during
infancy or childhood.
Behavioral health care – Assessment and treatment of mental or emotional disorders and chemical
dependency disorders.
Beneficiary – One who benefits from a publicly funded program. Most commonly used to refer to
people enrolled in the Medicare program.
Benefit level – The limit or degree of services a person is entitled to receive if the services are
medically necessary.
142
Section IV
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Billable activity – A service rendered to a Medicaid beneficiary for which a provider may request
Appendices
payment from the state.
Biologicals – Vaccines, cultures and other preparations made from living organisms and their products,
intended for use in diagnosing, immunizing or treating humans or animals or in related research.
Capitation – A prospective payment method that pays the provider of service a uniform amount for
each person covered, usually on a monthly basis. Capitation is used in managed care alternatives
such as MCOs.
Care coordination – An ongoing process including assessing a person’s needs and effectively planning,
arranging, coordinating and following up on services which most appropriately meet the identified
needs as mutually defined by that person, the access and assistance staff, and where appropriate, a family
member or other caregiver.
Care plan – A written plan prepared by the appropriate health care professionals.
Caregiver – A person who helps care for someone who is ill, has a disability or functional limitations and
requires assistance. Informal caregivers are relatives, friends or others who provide unpaid care. Paid
caregivers provide services in exchange for payment for the services rendered.
Caregiver education and training – This includes developing a resource library, developing information
resources, developing and/or facilitating support groups, seminars and focus groups, facilitating
individual or group counseling, and providing education services to groups or individuals.
Case manager – DADS staff who assist in the planning, coordination, monitoring and evaluation of
services for someone receiving services with an emphasis on quality of care, continuity of services
and cost effectiveness. (Note: In the Deaf Blind with Multiple Disabilities (DBMD) program, the case
manager is not DADS staff.)
Case management – A set of activities undertaken to ensure the waiver participant receives appropriate
and necessary services. Under a Home and Community-based Services waiver, these activities
may include assessment, service plan development, service plan implementation and service plan
monitoring, as well as assistance in accessing waiver, state plan and other non-Medicaid services and
resources.
Centers for Medicare & Medicaid Services (CMS) – The agency in the U.S. Department of Health and
Human Services that is responsible for federal administration of the Medicare, Medicaid and State
Children’s Health Insurance Program.
Certified Medicaid eligible – Someone who has gone through the Medicaid application process and has
been determined by the state to be eligible for the Medicaid program.
Change – A request for services resulting in an update or revision to community services being received
or to the plan of care for waiver services.
Chore maintenance – Performing household chores such as heavy cleaning (e.g., scrubbing floors,
washing walls and outside windows), moving heavy furniture, yard and walk maintenance that an older
person is unable to handle on their own and which do not require the services of a trained homemaker.
Chore services – Services needed to maintain a clean, sanitary and safe environment in an individuals
home, provided in the DBMD Waiver Program.
143
Client Assignment and Registration System (CARE) – An online data entry system that provides
demographic and other data about people served by local intellectual and developmental disability
authorities (LIDDAs), state supported living centers, Home and Community-based Services (HCS)
program providers, and Texas Home Living (TxHmL) program providers.
DADS
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Community Living Options Information Process (CLOIP) – Process by which DADS contracts with LIDDAs
to provide information about community living options to all adult residents of state supported living
facilities or their legally authorized representative at least once a year. Contracted LIDDAs are those with
a state supported living center in their service area.
Community Attendant Services (CAS) – An optional state plan benefit that allows states to provide home
and community-based services to eligible adults and children whose health problems cause them to
be functionally limited in performing activities of daily living according to a practitioner’s statement
of medical need. In Texas, this optional benefit provides personal care services to those who have
income in excess of SSI limitations but who would be financially qualified for services provided in an
institutional setting.
Community-based services – Services provided in the community, rather than in an institution.
Community services – Assistance and care for people who are older or those with disabilities. The goal of
community services is to help people remain as independent as possible.
Community Living Assistance and Support Services (CLASS) – A 1915(c) Medicaid waiver program that
provides community-based services and supports to people with developmental disabilities other than
intellectual disabilities as an alternative to living in an intermediate care facility.
Community Living Plan – A written agreement developed by a person’s interdisciplinary team with active
participation by that person and their legally authorized representative that details the responsibilities
of all parties signing the plan during and after the person’s move from a facility into a community living
arrangement.
Community mental health and intellectual disabilities centers – Public entities, locally governed
components of the mental health and intellectual and developmental disability service delivery
system located in communities throughout the state, providing community-based mental health and
intellectual and developmental disability services.
Compliance, Assessment, Regulation, Enforcement System (CARES) – DADS Regulatory Services
database system.
Congregate meal – Meals that comply with the Dietary Guidelines for Americans and provide a
minimum of one-third of the daily recommended dietary allowances as established by the Food and
Nutrition Board of the Institute of Medicine of the National Academy of Science served in a congregate
setting. These include standard meals and therapeutic meals/liquid supplements.
Conservator – A person appointed by the court in accordance with the Family Code for someone under
the age of 18 who acts as an agent for the child’s estate or person due to physical or mental limitations.
Consumer Directed Service (CDS) – CDS is a service delivery option in which an individual receiving
services, or their legally authorized representative, serves as the employer and assumes responsibilities
such as hiring, training and dismissing service providers. CDS employers must select a Financial
Management Services Agency (FMSA) to conduct financial management services such as payroll and
employer taxes.
144
Section IV
Consumer Managed Personal Attendant Services (CMPAS) – Personal care program in which the attendant
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is supervised by the service recipient.
Appendices
Continuity of services – Activities undertaken to ensure coordination of services to people within and
between components of the service delivery system.
Co-pay – A cost-sharing arrangement in which a covered person pays a specified amount for a specified
service. Payment is usually required at the time the service is rendered.
Contract – A formal, written agreement between DADS and a provider to deliver services to someone in
exchange for payment.
Contract manager – A person who is employed by the state and has significant contract management
duties for the state agency, as determined by the agency. This includes staff who enroll, monitor, manage,
supervise or oversee any DADS contracts, or who investigate complaints against DADS contractors.
Contractor– A person or organization with whom the state has negotiated an agreement for the
provision of required tasks.
Cost cap – A financial limit placed on a particular service or program.
Cost limit – The maximum amount available to a person for waiver services during the service
plan period.
Data warehouse – A system that stores data in formats useful for structured query and analysis.
Day – Any reference to day means calendar day (including weekends and holidays) unless otherwise
specified in the text.
Day activity and health services – An array of services provided in a congregate, non-residential setting
to dependent adults who need supervision but do not require institutionalization. These services may
include any combination of social or recreational activities, health maintenance, transportation, meals
and other supportive services.
Day activity health services facility – A licensed facility that provides day activity and health services or
adult day health services on a daily or regular basis, excluding overnight, to four or more people who are
older or have a disability.
Day Activity and Health Services (DAHS) – Daytime services designed to address the physical, mental,
medical and social needs of community residents as an alternative to placement in a nursing home or
other institution.
Deaf Blind with Multiple Disabilities (DBMD) – A 1915(c) Medicaid waiver program that provides
community-based services and supports to people has one or more diagnosed related conditions and,
as a result are deaf-blind, have a condition that will result in deaf-blindness or function as deaf blind
and have one or more additional disabilities that impair their independent functioning as an alternative
to living in an intermediate care facility.
Delegated health-related task – An activity the attendant may perform for someone only under a
physician or registered nurse’s delegation. Such tasks require physician’s order; must be delegated by a
physician in accordance with the Teas Medical Practice Act or by a registered nurse in accordance with
the Texas Nursing Practice Act; and must be supervised by the delegating authority.
145
Dental treatment – Emergency, preventative, therapeutic and orthodontic treatment.
Designated service area – A specific geographical region.
DADS
l
Developmental disability – A condition occurring before age 22 that is likely to continue indefinitely
and includes a mental or physical impairment or a combination of both. There must be a substantial
limitation in three or more of these major life areas: self-care, expressive or receptive language, learning,
mobility, capacity for independent living, economic self-sufficiency or self-direction.
Dietary services – A therapy service that assists a person to meet basic or special therapeutic nutritional
needs through the development of a personalized meal plan. The service is provided by a person
licensed in accordance with Texas Occupational Code, Chapter 701, Dietician.
Direct care staff – Any person who works directly with and helps people with daily needs.
Durable medical equipment (DME) – Equipment that can stand repeated use, is primarily and customarily
used to serve a medical purpose, generally is not useful to anyone who is not ill or injured, and is
appropriate for using at home.
Dual diagnosis – A term used to describe a person’s condition involving diagnosis of more than one type
of mental disability, such as mental illness occurring with intellectual and developmental disability, or
mental illness occurring with chemical dependency.
Dual eligible – Qualifying for both Medicare benefits and Medicaid assistance.
Emergency response services (ERS) – A service that provides 24-hour electronic monitoring services for
adults who live alone or who are isolated in the community.
Employment assistance – A service that helps people obtain competitive, integrated employment.
Enhanced match rate – Federal matching rate that is higher than the regular federal medical assistance
percentage.
Enhancement – An addition or variation to a minor home modification or an adaptive aid that is not
necessary to meet a person’s needs.
Enrollment – The entry of an applicant into a program.
Exploitation – An act of depriving, defrauding or otherwise obtaining someone’s personal property by
taking advantage of their disability or impairment.
Fair hearing – An administrative procedure that affords people the statutory right and opportunity
to appeal adverse decisions or actions regarding program eligibility or termination, suspension or
reduction of services by DADS.
Federal fiscal year (FFY) – The federal fiscal year is a 12-month period that begins on Oct. 1 and
ends Sept. 30.
Federal Medicaid Assistance Percentage (FMAP) – The percentage of federal money available to a state
to provide Medicaid services. This percentage is recalculated annually based on a formula designed to
provide a higher federal matching rate to states with a lower per capita income.
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Federal poverty levels (FPL) – Income amounts published annually by the federal government that are
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guidelines for determining eligibility for services.
Fee-for-service reimbursement – The traditional heath care payment system under which physicians and
other providers receive a payment for each unit of service they provide.
Financial Management Services (FMS) – Support provided by a financial management services agency
that is provided to people who direct some or all of their services, using the consumer directed services
option. This support includes operating a payroll service for the person’s employed workers and making
required payroll withholdings. This support may also include paying invoices for waiver goods and
services and tracking expenditures against the participant-directed budget.
Fraud – An intentional deception or misrepresentation with the knowledge the deception could result
in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud
under applicable federal or state law.
Freedom of choice – In general, a state must ensure that Medicaid beneficiaries are free to obtain
services from any qualified provider. Exceptions are possible through waiver of Medicaid and special
contract options.
Functional need – A person’s need for assistance with activities of daily living or instrumental activities
of daily living, caused by a physical or mental limitation or disability.
Guardian – A person appointed by the court to care for and/or handle the affairs of someone who is
deemed incompetent or incapable of administering his or her affairs. Guardian of the estate is appointed
to look after a person’s property. Guardian of the person has the legal authority to make personal
decisions for the person, including physical, medical and educational needs.
Habilitation – A broad term referring to procedures and intervention designed to help someone with
a developmental disability achieve greater mental, physical and social development. The habilitation
process enhances the person’s well-being, teaches skills and increases the possibility that he or she will
make progressively independent and responsible decisions about social behavior, quality of life, job
satisfaction and personal relationships.
Health Information, Counseling and Advocacy Program (HICAP) – In Texas the State Health Information
and Assistance Program (SHIP) is called the Health Information, Counseling and Advocacy Program
(HICAP). HICAP has been a component of the national SHIP Network since 1992.
Health maintenance – Services that include one or more of the following activities: medical treatment by
a health professional; health education and counseling services for individuals or groups about lifestyles
and daily activities; home health services including but not limited to nursing, physical therapy, speech
or occupational therapy; and provision of medications, nutritional supplements, glasses, dentures,
hearing aids or other assistive devices.
Health screening/monitoring – Investigation or analysis by a medical or health professional to determine
the need for a health service, including routine testing for blood pressure, hearing, vision, diabetes and
anemia, or the periodic checking/monitoring of a known condition such as monthly blood pressure
checks for hypertension or tests for anemia.
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Home and Community-based Services Waiver (HCS) – A 1915(c) Medicaid waiver program that provides
community-based services and supports for people with an intellectual and developmental disability or
related conditions as an alternative to living in an intermediate care facility.
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Home and community support services agencies (HCSSA) – A licensed entity that provides home health,
DADS
hospice, or personal assistance services to people in a residence or independent living environment.
Home health services – One or more health services required by someone in a residence or independent
living environment. Home health services include: nursing; physical, occupational, speech or respiratory
therapy; medical and social services; intravenous therapies; dialysis; services by unlicensed personnel
under the delegation or supervision of a licensed health professional; medical equipment and supplies
(excluding drugs); or nutritional counseling.
Home-delivered meal – A nutritious meal delivered to an eligible person in his or her home and that
complies with the Dietary Guidelines for Americans, providing a minimum of one-third of the daily
recommended dietary allowances as established by the Food and Nutrition Board of the Institute of
Medicine of the National Academy of Science.
Homemaker – A service provided by trained and supervised people involving the performance of
housekeeping/home management, meal preparation or escort tasks and shopping assistance, provided
to those who require assistance with these activities in their home. The objective is to help the person
sustain independent living in a safe and healthful home environment.
Hospice – An array of special palliative services provided to terminally ill people and their families or
caregivers. The goal of hospice is to care for the person and the family during the final stages of life.
Hospice is available for all age groups and includes physical and emotional care provided by a team of
doctors, nurses, hospice aides, social workers, counselors and trained volunteers. Hospice services may
be provided in the home or other residential settings, or in an inpatient facility.
Imminent danger – An immediate, real threat to someone’s safety.
Information, referral and assistance – Assessing persons’ needs by:
l
Finding organizations capable of meeting the needs.
l
Evaluating all appropriate resources.
l
Providing enough information about each resource to help them make informed choices.
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Helping them find alternative resources.
l
Actively linking persons to needed services.
l
Performing follow-up to ensure the services were provided.
Individual Plan of Care (IPC) or Individual Service Plan (ISP) – A document that describes the type and
amount of services to be provided to a person.
In-Home and Family Support Program (IHFSP) – A program that disburses funds as assistance to people
with physical disabilities or their families to buy services or items that are above and beyond the scope of
usual needs, that are necessitated by the disability, and that directly support the person in living in his or
her own home rather than living in a more restrictive setting at a higher cost.
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Instruction and training – These services provide the experience and/or knowledge for those working
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with people to acquire skills in a formal, informal, individual or group setting.
Intellectual and developmental disability (IDD) – Severe chronic disabilities that can be cognitive
(appearing before age 18), or physical (appearing before age 22), or both, and are likely to be lifelong.
Intellectual and developmental disability priority population – Those groups identified by DADS as being
most in need of intellectual and developmental disability services.
Intellectual disability (ID) – A condition manifested before the age of 18 that includes significantly sub-
average intellectual functioning (an intelligence quotient of approximately 70 or below) and deficits or
impairments in adaptive functions.
Intellectual Disability and Related Condition Assessment (ID/RC) – An assessment used by DADS for
making a level of care determination and a level of need assessment.
Interest list – Lists that are maintained by program with names of persons who have contacted DADS
and expressed an interest in receiving services for which there is currently no funding. Names are
released from the interest lists as funding becomes available. Interest lists for community-based
programs are managed either locally or statewide, depending on the program.
Intermediate Care Facility for Persons with ID (ICF/IID) – A public or private facility that provides health
and habilitation services to people with intellectual and developmental disabilities.
Intervener – A service provider with specialized training and skills in deaf blindness who, working with
one individual at a time, serves as a facilitator to involve an individual in home and community services
and activities, and who is classified as an “Intervener”, “Intervener I”, “Intervener II”, or “Intervener III”
in accordance with Texas Government Code, § 531.0973.
Legal awareness – The dissemination of accurate, timely and relevant information, eligibility criteria,
requirements and procedures to older people about public entitlements, health/long-term care,
individual rights, planning/protection options, housing and individual issues in a group setting.
Legally authorized representative (LAR) – A person authorized by law to act on behalf of another person
and may include a parent, guardian or managing conservator of a minor, or the guardian of an adult.
Level of care (LOC) – The specification of the minimum amount of assistance that a person must require
in order to receive services in an institutional setting under the state plan.
Level of need (LON) – An assignment given to someone by DADS upon which reimbursement for specific
waiver services is based. The LON assignment is derived from DADS-approved standardized tests.
Licensed Vocational Nurse (LVN) – A person licensed by the Board of Nurses for the State of Texas who
works under the supervision of a registered nurse or a physician’s assistant.
Local Intellectual and Developmental Disability Authority (LIDDA) –In accordance with the Texas Health
and Safety Code, §533.035, an entity to which the Texas Health and Human Services Commission
executive commissioner delegates the state’s authority for planning, policy development, coordination,
including coordination with criminal justice entities, resource allocation and resource development for
oversight of intellectual disability services in one or more service areas.
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Long-term Care Ombudsman – Provides services to help protect the health, safety, welfare and rights
of residents of nursing homes and assisted living facilities and to identify, investigate and resolve
complaints made by or on behalf of residents and that relate to action, inaction or decisions that may
adversely affect residents.
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Long-Term Services and Supports (LTSS) – Services provided to someone in the home or other
community-based setting that are necessary to allow the them to remain in the most integrated
setting possible.
Managed care – A system in which the overall care of a patient is overseen by a single provider or
organization. Many state Medicaid programs include managed-care components as a method of
improving quality and controlling costs.
Managing conservator – A court-appointed person with possession rights to a child in accordance
with state law.
Medicaid – A federal medical assistance program for certain people with low income. Medicaid is
financed by both federal and state funds. Each state designs and administers its own program under
the general oversight of the U.S. Department of Health and Human Services. The program was enacted
in 1965 under Title XIX of the Social Security Act.
Medical Assistance Only (MAO) – Someone who is eligible for Medicaid benefits but receives
no cash assistance.
Medicaid eligible (ME) – Someone who has been determined eligible to receive Medicaid coverage
based on Medicaid program guidelines.
Medicaid Estate Recovery Program (MERP) – A program that allows state Medicaid programs to recover a
portion of the money spent on long-term care for Medicaid beneficiaries age 55 or older upon their death.
Medical Necessity (MN) – A determination given to people based on an assessment used to certify
eligibility for placement in a nursing facility.
Medical Necessity and Level of Care Assessment (MN/LOC) – An assessment completed by a registered
nurse and used by the contracted medical necessity determination provider to establish medical
necessity and level of care for an applicant or person.
Medically Dependent Children Program (MDCP) – A 1915(c) Medicaid waiver program that provides
respite, flexible family support services, minor home modifications, adaptive aids, financial management
services, employment assistance, supported employment and transition assistance services to children
under age 21 as an alternative to nursing facility care.
Medicare – The nation’s largest health insurance program financed by the federal government.
The program provides insurance to people age 65 and older, who are disabled, or who have permanent
kidney failure.
Medicare eligible – A person who is older or who has a disability who receives Social Security or railroad
retirement benefit payments and meets eligibility criteria to have certain medical expenses paid by the
federal Medicare program.
Medicare Part A – Medicare hospital insurance that helps pay for medically necessary inpatient
hospital care, and, after a hospital stay (for a limited period of time), for inpatient care in a skilled
nursing facility, for home care by a home health agency or hospice care by a licensed and certified
hospice agency.
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Medicare Part B – Medicare medical insurance that helps pay for medically necessary physician services,
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outpatient hospital services, outpatient, physical therapy and speech pathology service, and a number of
other medical services and supplies that are not covered by the hospital insurance.
Medicare Part C – Previously called Medicare+Choice, this part of the Medicare program was
renamed Medicare Advantage and modified by the Medicare Prescription Drug, Improvement and
Modernization Act of 2003. It provides for certain managed care coverage options in Medicare, under
which managed care organizations receive a capitated monthly payment per covered beneficiary.
Medicare Part D – A voluntary Medicare prescription drug benefit created by the Medicare Prescription
Drug, Improvement and Modernization Act of 2003 that began Jan. 1, 2006. Beneficiaries who remain in
traditional Medicare may choose a private drug-only plan; those who choose to enroll in a managed care
organization may choose a plan that offers a drug benefit.
Mental illness – A single severe mental disorder, excluding an intellectual and developmental disability,
or a combination of several mental disorders as defined in the latest edition of the American Psychiatric
Association’s Diagnostic and Statistical Manual on Mental Disorders.
Minor – Someone under 18 years of age.
Minor home modification (MHM) – A physical adaptation to a person’s home that is essential for the
resident’s safe access to and movement within the home; facilitates self-reliance and independence; and
allows the resident to remain safely in the community, return safely to the community, or function with
greater independence.
Money Follows the Person (MFP) – A policy that allows residents of nursing facilities to move into
certain Medicaid waiver programs without having to wait on the interest list upon determination
of waiver eligibility.
Neglect – The failure to provide a person the reasonable care required, including but not limited to food,
clothing, shelter, medical care, personal hygiene or protection from harm.
Nursing facility (NF) – A residential institution that primarily provides skilled nursing care and related
services for residents who require medical or nursing care; rehabilitation services for the rehabilitation
of a person who is injured, disabled or sick; or health-related care and services, on a regular basis, to
people who, because of their mental or physical condition, require care and services, above the level
of room and board, which can be made available to them only through institutional facilities.
Nursing services – A reimbursable service provided by licensed nursing personnel in accordance with
Texas Occupational Code, Chapter 301.
Nutrition consultation – The provision of information related to nutrition by a licensed dietitian or other
qualified person. Services are to be provided by AAAs or nutrition providers.
Nutrition counseling - Individualized advice or guidance about options and methods for improving
nutritional status for those who are at nutritional risk because of their health or nutritional history,
dietary intake, medication use or chronic illness. Counseling is performed by a health professional in
accordance with state law and policy.
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Nutrition education – Provision of information to promote nutritional well-being.
Older person – Someone age 60 or older.
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Omnibus Budget Reconciliation Act(s) (OBRA) – Federal laws that provide direction regarding how
DADS
federal funds are to be spent. Amendments to Medicaid eligibility and benefit rules are frequently
made in these acts.
Permanency planning – A philosophy and planning process that focuses on the services and supports
needed for children with disabilities to live with families.
Person-directed Plan (PDP) – A process that empowers a person or the legally authorized representative,
or both, to direct the development of a plan of services and supports that meets their desired outcomes.
Personal assistance services – Routine, ongoing care or services required by an individual in a residence
or independent living environment that enable the individual to engage in the activities of daily living or
to perform the physical functions required for independent living, including respite services. The term
includes personal care and health-related tasks or services performed by unlicensed personnel that are
either delegated by a registered nurse or that do not require delegation.
Personal care tasks – Assistance with meals, dressing, movement, bathing or other personal needs or
maintenance; the administration of medication by a person licensed to administer medication or the
assistance with or supervision of medication; or general supervision or oversight of the physical and
mental well-being of someone who needs assistance to maintain a private and independent residence
in an assisted living facility or who needs assistance to manage personal affairs, regardless of whether a
guardian has been appointed.
Personal leave – An absence from a residential setting for personal reasons.
Personal Needs Allowance – Money people are permitted to keep from their incomes to pay for
personal items.
Personal support team (PST) – A group of people drawn from or representing those professions,
disciplines, service areas or agencies that are relevant to identifying a person’s needs and designing a
program to meet those needs. Also known as an interdisciplinary team by the ICFs/IID regulations and
licensing rules and contracting rules 40 Texas Administrative Code (TAC) §9.203.36.
Preadmission Screening and Resident Review (PASRR) – A federally-mandated evaluation process to
identify people with mental illness (MI) or an intellectual or and developmental disability (IDD) who
are seeking admission to a nursing facility or who already live in a nursing facility. The purpose of
PASRR is to ensure nursing facility placement is appropriate and people with MI or IDD receive the
necessary services to meet their needs.
Preventive care – Comprehensive care that emphasizes prevention and early detection and treatment of
conditions, generally including physical examination, immunization and well-person care.
Primary Home Care (PHC) – A Medicaid-funded community care program that provides non-technical
attendant services to people who are older and those with disabilities. Recipients must be age
21 or older.
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Prior authorization – A mechanism to control the use of covered items (e.g., durable medical equipment,
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prescription drugs) or services (e.g., inpatient hospital care). Payment is not made unless approval for
the item or service is obtained in advance either from state agency personnel or from a state fiscal agent
or other contractor.
Program of All Inclusive Care for the Elderly (PACE) – A Medicaid state plan program that allows Texas
to provide comprehensive community and medical services under a capitated, risk-based system to
people 55 years of age or older who qualify for nursing facility placement. PACE uses a comprehensive
approach, providing an array of services as a cost-effective alternative to nursing facility services.
Program provider – An entity that provides services under a contract with DADS.
Promoting Independence (PI) – This is a state initiative in response to the U.S. Supreme Court ruling in
Olmstead v. Zimring mandating that states provide community-based services to people with disabilities
who would otherwise be entitled to institutional services when certain conditions are met.
Qualified Disabled and Working Individuals (QDWI) – Medicare beneficiaries with an income limit of
200 percent of the federal poverty level who do not qualify for full Medicaid benefits. Medicaid pays
Medicare Part A premiums for disabled working people.
Qualified Individuals (QI) – Medicare beneficiaries with an income limit of 175 percent of the
federal poverty level who do not quality for full Medicaid benefits. Medicaid pays their Medicare
Part B premium.
Qualified Medicare Beneficiary (QMB) – Medicare beneficiaries with an income limit of 100 percent of the
federal poverty level who do not quality for full Medicaid benefits. Medicaid pays all of their Medicare
Part A and B premiums, deductibles and coinsurance.
Quality Improvement (QI) – A continual process that identifies problems in service delivery, tests
solutions to those problems and constantly monitors the solutions for improvements.
Quality monitor – A function that provides external review of the access to and the quality of care
provided to Medicaid consumers enrolled in Medicaid managed care.
Related condition (RC) – A severe chronic disability attributed to a condition other than mental illness.
This disability results in impairment of general intellectual functioning or adaptive behavior or both
similar to that of an intellectual disability and requires treatment or services similar to those required
by someone with an intellectual disability. The condition must be manifested before the age of 22, must
be likely to continue indefinitely and must result in substantial functional limitations. A more specific
definition is found at 40 TAC §9.203.72.
Registered Nurse (RN) – A person licensed by the Board of Nursing for the State of Texas to practice
professional nursing.
Residential care – A community services and supports program that provides services to eligible adults
who require access to services on a 24-hour basis, but who do not need daily nursing intervention.
Residential repair – Repairs or modifications of consumer-occupied dwellings that are essential for the
health and safety of the occupants.
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Resource Utilization Group (RUG) – A level of care determination that is used to establish payment
levels to nursing facilities and cost limits for people receiving MDCP and HCBS STAR+PLUS
Waiver services.
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Respite – Care provided on a short-term basis which results in temporary relief for unpaid primary
caregivers. Respite services are provided either in or out of the home.
Room and board – “Room” means shelter type expenses, including all property-related costs such as
rental or purchase of real estate and furnishings, maintenance, utilities, and related administrative
services. “Board” means three meals a day or any other full nutritional regimen.
Semi-ambulatory – Mobility relying on the assistance of a device, object or person.
Service coordination – A system in which a single accountable staff person provides assistance to an
applicant, individual or legally authorized representative in accessing medical, social, educational and
other appropriate services and supports that will help a person achieve a quality of life and community
participation acceptable to them.
Service coordinator (SC) – A person who performs service coordination.
Service back-up plan – A plan that ensures continuity of services if service delivery is interrupted.
Service delivery area (SDA) – Regions of the state established by the Texas Health and Human Services
Commission for the purpose of planning and providing services.
Service plan – A written document that specifies all services, waiver and others regardless of funding,
along with any assistance or informal supports people require to live in the community and avoid
institutionalization. At a minimum, the service plan must contain the service, amount, frequency,
duration, provider and cost.
Service planning team – A planning team for each person consisting of, at a minimum, the person,
legally authorized representative and service coordinator or case manager. The person or legally
authorized representative may invite others to participate in planning.
Service Responsibility Option (SRO) – A service delivery model in which the recipient has the ability to
train personal attendants.
Signature – A person’s name or mark representing his or her name on a document.
Skilled nursing facility (SNF) – An institution or distinct part of a family that participates in the Medicare
program and is primarily engaged in providing skilled nursing care and related services for residents
who require medical or nursing care, or rehabilitation services for the rehabilitation of the injured,
disabled or sick, or on a regular basis, health-related care and services to those who, because of their
mental or physical condition, require care and services (above room and board) that can be made
available to them only through institutional facilities and is not primarily for the care and treatment of
mental disorders. SNF requirements apply when a certified facility is billing Medicare for a resident’s
per diem rate.
Social Security Administration (SSA) – The federal agency responsible for determining eligibility for
Supplemental Security Income (SSI) benefits in Texas and most other states.
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Specialized therapies – A service component that provides assessment and treatment by appropriately
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licensed or certified professionals.
Specified Low-income Medicare Beneficiaries (SLMB) – Medicare beneficiaries with an income limit of
120 percent of the federal poverty level who do not qualify for full Medicaid benefits. Medicaid pays the
Medicare Part B premium.
State fiscal year (SFY) – The Texas state fiscal year begins on Sept. 1 and runs through Aug. 31.
State Health Information and Assistance Program (SHIP) – A grant funded by the Centers for Medicare
& Medicaid and traditionally referred to as the CMS Basic Grant. Funds are allocated to AAAs via a
request for proposal process.
State of Texas Access Reform Plus Managed Care (STAR+PLUS) – A 1115 Medicaid waiver program
approved for the managed care delivery system designed to allow people who qualify for nursing facility
care to receive long-term services and supports in order to be able to live in the community.
State Supported Living Center (SSLC) – A state-operated ICF/IID providing campus-based residential
services for people with an intellectual disability. DADS operates 12 state supported living centers as well
as the ICF component of the Rio Grande State Center.
Supplemental Security Income (SSI) – A federal entitlement program established under Title XVI of the
Social Security Act to provide cash assistance to certain people who are older, blind, or disabled and
whose income and resources fall below the Social Security income and resources standards that are set
by the federal government.
Support consultation – An optional service provided by a support advisor that provides a level of
assistance and training beyond that provided by the Consumer Directed Services Agency through
Financial Management Services.
Supported employment (SE) – A service that helps people to sustain competitive, integrated employment.
Suspension – A temporary cessation of any waiver service without the loss of Medicaid or program
eligibility.
Termination – A term used when someone no longer meets the program’s eligibility criteria and services
are ended.
Texas Accessibility Standards – Federal and state standards merged to comply with the Americans with
Disabilities Act.
Texas Department of Aging and Disability Services (DADS) – Texas state agency that provides long-term
services and supports to people who are older and those with physical, intellectual and developmental
disabilities. DADS also regulates providers of long-term services and supports and administers the state’s
guardianship program.
Texas Health and Human Services Commission (HHSC) – The oversight agency for health and human
services in Texas and the single state Medicaid agency for Texas.
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Texas Home Living (TxHmL) – A 1915(c) Medicaid waiver program that provides community-based
services and supports to people with intellectual disabilities or related conditions who live in their own
homes or their family’s homes as an alternative to living in an intermediate care facility.
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Texas Integrated Eligibility and Redesign System (TIERS) – A project created to improve the delivery of
DADS
state-funded services. The project replaces several outdated automated systems with a state of the art
integrated eligibility system and improves service delivery.
Third-party resource – An item, service or funds available to someone from a source other than the
waiver or program such as Medicare, Medicaid Home Health, Texas Health Steps Comprehensive Care
Program, private insurance, family support, community support or local school districts.
Titles of the 1965 Social Security Act:
I I – Old age, Survivors and Disability Insurance Benefits.
IV-A – Temporary Assistance for Needy Families; WIN Social Services
l IV-B – Child Welfare
l IV-D – Child Support
l IV-E – Foster Care and Adoption
l IV-F – Job Opportunities and Basic Skills Training
l V – Maternal and Child Health Services
l XVI – Supplemental Security Income
l XVIII – Medicare
l XIX – Medicaid
l X X – Social Services
l X XI – Children’s Health Insurance Program
l
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Transfer – The movement of someone from one program to another program; from one provider to
another provider; or between service delivery options.
Transition Assistance Services (TAS) – One-time service provided to a Medicaid-eligible resident of
a nursing facility located in Texas to assist the resident in moving from the nursing facility into the
community.
Trust fund – The funds of a service recipient that are managed by a provider in a specific account with
specific guidelines that must be followed.
Transportation – Taking a person who is older or someone with a disability from one location to
another.
Utilization Review (UR) – A formal assessment of the medical necessity, efficiency or appropriateness of
services and treatment plans on a prospective, concurrent or retrospective basis.
Vendor hold – Temporary suspension of payment from DADS to a service provider.
Waiver – An exception to the usual requirements of a Medicaid grant to a state by the Centers for
Medicare & Medicaid Services.
Working day – Any day DADS is open for business except Saturday, Sundays and recognized holidays.
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Acronyms
Access and Intake
AA
Adaptive aids
AAA
Area agency on aging
AAIDD
American Association on Intellectual and Developmental Disabilities
AAPCC
Adjusted average per capita cost
ACS
Affiliated computer services
ADA
Americans with Disabilities Act
ADRC
Aging and disability resource center
AFC
Adult Foster Care
AIC
Area information center
ALF
Assisted living facility
APS
Adult Protective Services
AR
(Legally) authorized representative
BBA
Balanced Budget Act
BHO
Behavioral health organization
CARE
Client Assignment and Registration System
CARES
Compliance, Assessment, Regulation, Enforcement System
CAS
Community Attendant Services
CCAT
Community Care Assessment Tool
CS
Community Services
CCP
Comprehensive Care Program
CDS
Consumer Directed Services
FMSA
Financial Management Services Agency
CHIP
Children’s Health Insurance Program
CLASS
Community Living Assistance and Support Services
CLO
Community Living Option
CLOIP
Community Living Options Information Process
CMPAS
Consumer Managed Personal Attendant Services
CMS
Centers for Medicare & Medicaid Services (formerly HCFA)
CMS
Claims Management System
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A&I
157
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DADS
CPI
Center for Policy and Innovation
CPS
Child Protective Services
CSHCN
Children with Special Health Care Needs
CSPO
Community Services and Program Operations
DADS
DAHS
DARS
Texas Department of Assistive and Rehabilitative Services
DBMD
Deaf Blind with Multiple Disabilities
DFPS
Texas Department of Family and Protective Services
DID
Determination of Intellectual Disability
DME
Durable medical equipment
DSHS
Texas Department of State Health Services
ECI
Early Childhood Intervention
EMR
Employee Misconduct Registry
EPSDT
Early Periodic Screening, Diagnosis and Treatment
EOA
Equity of access
ERS
EWS
Early Warning System
FFP
Federal Financial Participation
FFSFee-for-service
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FFY
Federal fiscal year
FGP
FMAP
Federal Medicaid Assistance Percentage
FMS
Financial Management Services
FPL
Federal poverty level
GOBPP
Governor’s Office of Budget, Planning and Policy
HB
House Bill
HCS
Home and Community-based Services
HCSSA
Home and Community Support Services Agencies
HDM
Home-delivered meals
HHS
Texas Health and Human Services
HHSC
Texas Health and Human Services Commission
Health Insurance Portability and Accountability Act
HMO
Health Maintenance Organization
HUB
Historically Underutilized Business
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HIPAA
l
Health Information, Counseling and Advocacy Program
Section IV
HICAP
ICF/IIDIntermediate Care Facility or Facilities for Individuals with an Intellectual Disability
or Related Condition
ID
Intellectual disability
IDD
IHFSP In-Home and Family Support Program
IPC
Individual plan of care
ISP
Individual service plan
IT
Information technology
LIDDA
Local intellectual and developmental disability authority
LAR
Legally authorized representative
LBB
Legislative Budget Board
LOC
Level of care
LON
Level of need
LTC
Long-term care
LTSS
Long-term Services and Supports
LVN
Licensed Vocational Nurse
MAC
Medicaid Administrative Claiming
MAO
Medical Assistance Only
MCAC
Medical Care Advisory Committee
MCO
Managed care organization
MDCP
Medically Dependent Children Program
MDU
Multiple Disabilities Unit (state hospitals)
ME
Medicaid eligible
MERP
Medicaid Estate Recovery Program
MFP
Money Follows the Person
MH
Mental health
MHM
Minor home modifications
MMIS
Medicaid Management Information System
159
l
DADS
160
MN
Medical necessity
MN/LOC
Medical necessity/level of care
MOU
Memorandum of understanding
NAR
Nurse Aide Registry
NATCEP
Nurse Aide Training and Competency Evaluation Program
NF
Nursing facility
NFA
Nursing facility administrator
NFCSP
National Family Caregiver Support Program
OAA
Older Americans Act
OBRA
Omnibus Budget Reconciliation Act
OIG
Office of Inspector General
OT
Occupational therapy
PACE
Program of All-inclusive Care for the Elderly
PASRR
Preadmission Screening and Resident Review
PCP
Primary care physician
PDP
Person-directed plan
PHC
Primary Home Care
PI
PMAB
Prevention and management of aggressive behavior
PMO
Project Management Office
PNA
Personal Needs Allowance
POS
Point of service
PPECC
Prescribed pediatric extended care centers
PCS
Provider Claims Services
PST
Personal support team
PT
Physical therapy
QMP Quality Monitoring Program
QI
Qualified Individuals
QDWI
Qualified Disabled and Working Individuals
QI
Quality improvement
QMB
Qualified Medicare Beneficiary
QIDP
Qualified ID Professional
Recommended dietary allowance
RFO
Request for offers
RFP
Request for proposals
RN
Registered Nurse
RSA
Rural Service Area (Medicaid)
Appendices
RDA
l
Related condition or residential care
Section IV
RC
RSSResidential Support Services (or Refugee Social Services.)
RSVP
Retired and Senior Volunteer Program
RUG
Resource Utilization Group
SAO
State Auditor’s Office
SAVERR
System for Application, Verification, Eligibility, Referrals and Reports
SB
Senate Bill
SC
Service coordination/coordinator
SCP
Senior Companion Program
SDA
Service delivery area
SFY
State fiscal year
SHIP
State Health Information and Assistance Program
SHL
Supported home living
SL
Supervised living
SLMB
Specified Low-Income Medicare Beneficiaries
SMI
State median income
SNF
Skilled nursing facility
SRO
Service Responsibility Option
SSA
Social Security Administration
SSDI
Social Security Disability Income
SSI
Supplemental Security Income
SSLC
State supported living center
SSPD-SAC
Special Services to Persons with Disabilities 24-Hour Shared Attendant Care
STAR+PLUS
State of Texas Access Reform plus Managed Care
SUA
State Unit on Aging
TANF
Temporary Assistance for Needy Families
TAS
Transition Assistance Services
161
l
DADS
162
TIERS
Texas Integrated Eligibility Redesign System
TLC
Transition to Life in the Community
TLRCP
Texas Lifespan Respite Care Program
TMHP
Texas Medicaid and Healthcare Partnership
TPR
Third Party Resource
TxHmL
Texas Home Living Waiver
UR
Utilization Review
INSIDE BACK COVER
P.O. Box 149030 H Austin, Texas 78714-9030
www.dads.state.tx.us
DADS Media Services 16D0022 H May 2016 H Publication 287

Texas Department of Aging and Disability Services 2016 Reference

Transcription

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